Multi-domain lifestyle intervention in older adults after myocardial infarction: rationale and design of the PIpELINe randomized clinical trial

Elisabetta Tonet, Andrea Raisi, Silvia Zagnoni, Giorgio Chiaranda, Rita Pavasini, Francesco Vitali, Federico Gibiino, Roberta Campana, Alberto Boccadoro, Antonella Scala, Luca Canovi, Veronica Amantea, Camilla Matese, Maria Letizia Berloni, Tommaso Piva, Valentina Zerbini, Laura Sofia Cardelli, Giovanni Pasanisi, Gianni Mazzoni, Gianni Casella, Giovanni Grazzi, Gianluca Campo, Elisabetta Tonet, Andrea Raisi, Silvia Zagnoni, Giorgio Chiaranda, Rita Pavasini, Francesco Vitali, Federico Gibiino, Roberta Campana, Alberto Boccadoro, Antonella Scala, Luca Canovi, Veronica Amantea, Camilla Matese, Maria Letizia Berloni, Tommaso Piva, Valentina Zerbini, Laura Sofia Cardelli, Giovanni Pasanisi, Gianni Mazzoni, Gianni Casella, Giovanni Grazzi, Gianluca Campo

Abstract

Background: Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking.

Aim: To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial.

Methods: The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes.

Results: The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024.

Conclusions: The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI.

Trial registration: ClinicalTrials.gov NCT04183465.

Keywords: Exercise intervention; Lifestyle intervention; Myocardial infarction; Older patients.

Conflict of interest statement

The author declares no conflicts of interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Inclusion and exclusion criteria and study design. MI: myocardial infarction. SPPB short physical performance battery, PCI percutaneous coronary intervention, LVEF left ventricular ejection fraction, NYHA New York Heart Association, SPMSQ short portable mental status questionnaire, CHAMPS Community Healthy Activities Model Program for Seniors, EQ5D Euro quality of life five domains, CV cardiovascular, CVA cerebrovascular accident
Fig. 2
Fig. 2
Description and interpretation of SPPB scale. SPPB short physical performance battery

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