Sydäninfarktin jälkeisen kuntoutuksen osallistumisen parantaminen toissijaisen sydäninfarktin jälkeen lääkärin viesteillä ja motivoivilla puheluilla (ATTEND-CR)
Tiimien ja Potilaiden Aktivointi Sydänkuntoutuksen Osallistumisen Parantamiseksi Toissijaisen Sydäninfarktin Jälkeen (ATTEND-CR) -Tutkimus
The goal of this clinical trial is to determine if a behavioral intervention can increase attendance at cardiac rehabilitation (CR) after secondary/type 2 myocardial infarction in adult patients. The main question it aims to answer is:
- Does the ATTEND-CR intervention increase attendance at ≥1 CR exercise session within 140 days of randomization?
- Does the intervention increase completion of ≥12 CR exercise sessions within 140 days of randomization?
Researchers will compare participants receiving the ATTEND-CR intervention (clinician notifications and a motivational interviewing participant phone call) to usual care to see if attendance and completion of CR improve.
Participants:
- Clinicians will receive informational messaging regarding CR and the referral process
- Participate in a motivational interviewing phone call (intervention group only)
- Have follow-up assessments via telephone and electronic health record (EHR) review to track CR attendance, clinical events, and health outcomes
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
The ATTEND-CR trial ("Activating Teams and Patients to Enhance Attendance at Cardiac Rehabilitation After Secondary Myocardial Infarction") is a single-center pilot randomized clinical trial designed to evaluate strategies to increase participation in cardiac rehabilitation (CR) among patients hospitalized with secondary/type 2 (demand/supply mismatch) myocardial infarction (MI). Although CR has been demonstrated to improve functional capacity, quality of life, and cardiovascular outcomes after acute MI, participation rates remain low, particularly in patients with secondary/type 2 MI. This study tests whether a low-risk, behavioral intervention can improve attendance in CR programs.
Participants are randomized to either the ATTEND-CR intervention or usual care. The intervention consists of informational messaging to clinicians regarding CR and the referral process, combined with a follow-up phone call to the patient applying principles of motivational interviewing to support their attendance at CR. Usual care participants receive standard post-MI management without study-driven notifications or motivational support.
Participants are followed for 140 days post-randomization. Study procedures include remote follow-up calls and review of electronic health records to capture participation in CR, clinical events, medication use, and patient-reported health status. The study team monitors safety throughout the trial, focusing on adverse events occurring during or shortly after CR sessions and any serious adverse events that arise during the follow-up period.
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
Opiskeluyhteys
- Nimi: Cian McCarthy, MB, BCh, BAO, SM
- Puhelinnumero: 617-726-2000
- Sähköposti: CMCCARTHY37@MGB.ORG
Tutki yhteystietojen varmuuskopiointi
- Nimi: Connor Suscha, BS
- Puhelinnumero: 617-643-2130
- Sähköposti: csuscha@mgh.harvard.edu
Opiskelupaikat
-
-
Massachusetts
-
Boston, Massachusetts, Yhdysvallat, 02114
- Rekrytointi
- Massachusetts General Hospital
-
Ottaa yhteyttä:
- Connor Suscha, BS
- Puhelinnumero: 617-643-2130
- Sähköposti: csuscha@mgh.harvard.edu
-
Ottaa yhteyttä:
- Cian McCarthy, MB, BCh, BAO
- Puhelinnumero: 617-726-2000
- Sähköposti: CMCCARTHY37@MGB.ORG
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- Age ≥ 18 years
- Inpatient at MGH with an index likely or confirmed secondary MI
- Primary care provider (PCP) within the Mass General Brigham (MGB) network with at least one visit in the past 2 years
- Anticipated ability to ambulate independently without walking aids or supplemental ambulatory oxygen at discharge
- Ability to provide informed consent
Exclusion Criteria:
- Known severe untreated valvular heart disease or severe prosthetic valve dysfunction
- Known hypertrophic obstructive cardiomyopathy
- End-stage heart failure (VAD, transplant patient, or undergoing evaluation for VAD or transplant)
- Hemodynamic instability at the time of pre-screening
- Terminal illness with life expectancy < 1 year
- Severe anemia (hemoglobin < 8 g/dL) at the time of pre-screening
- Active, unstable cancer (excluding non-metastatic skin cancer) or currently receiving intensive cancer therapy
- Advanced kidney disease requiring renal replacement therapy
- Receiving palliative or comfort care only
- Recurrent falls (≥2) or falls with injury in the past year
- Physical or cognitive impairment likely to prevent safe participation in exercise over the next 5 months (e.g., significant stroke deficits, dementia)
- High-risk for non-adherence to study requirements
- Incarcerated individuals
- Currently pregnant or within 3 months postpartum
- Previously referred to or participated in CR within the past year
- Alternative MI subtype (spontaneous [type 1 MI] or procedural MI [type 4 or 5 MI]) in the past 6 months
- Suspected or confirmed coronary mechanism of index MI (vasospasm, embolism, or spontaneous coronary artery dissection)
- Anticipated discharge or discharged before enrollment measures can be completed
- Anticipated discharge to a facility where independent participation in CR is not feasible
- Previously enrolled in or declined participation in this study
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
|---|---|
|
Kokeellinen: Intervention Arm (ATTEND-CR):
Participants clinicians receive an informational message about cardiac rehabilitation and the cardiac rehabilitation referral process. Participants who are referred to cardiac rehabilitation receive a phone call post-discharge applying principles of motivational interviewing. The goal is to encourage cardiac rehabilitation attendance. |
The inpatient clinical team receives an EPIC in-basket and email detailing the patient's study participation, benefits of cardiac rehabilitation, and guidance on how to place a cardiac referral if appropriate. If a cardiac rehabilitation referral is not placed within 3 days post-discharge, a follow-up message is sent to one of the patient's outpatient clinician within 4-28 days post-discharge and within 140 days of randomization. Participants receive a phone call applying motivational interviewing principles if a cardiac rehabilitation referral has been placed by their clinical team within 56 days post-discharge and within 140 days of randomization. The phone call aims to discuss cardiac rehabilitation, barriers to participation, and support engagement in cardiac rehabilitation. |
|
Ei väliintuloa: Usual Care Arm
Participants receive standard post-MI care without clinician informative messaging or a motivational interviewing phone call from the study team. They may still be referred to and attend CR based on usual clinical practice. |
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Number of Participants Who Attended one or more Cardiac Rehabilitation Exercise Session
Aikaikkuna: Within 140 days (inclusive) post-randomization
|
Attendance at one or more cardiac rehabilitation exercise session |
Within 140 days (inclusive) post-randomization
|
Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Number of Participants With a Cardiac Rehabilitation Referral
Aikaikkuna: Within 140 days (inclusive) post-randomization
|
Referral to a cardiac rehabilitation program |
Within 140 days (inclusive) post-randomization
|
|
Number of Participants who Completed Cardiac Rehabilitation
Aikaikkuna: Within 140 days (inclusive) post-randomization
|
Completion defined as attendance at ≥12 cardiac rehabilitation exercise sessions |
Within 140 days (inclusive) post-randomization
|
|
Feasibility indicators
Aikaikkuna: Recruitment Time Frame: Through completion of enrollment, an average of 18 months. Retention Time Frame: Through completion of participant follow-up, an average of 20 weeks.
|
|
Recruitment Time Frame: Through completion of enrollment, an average of 18 months. Retention Time Frame: Through completion of participant follow-up, an average of 20 weeks.
|
Muut tulostoimenpiteet
Muut tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
All-cause mortality
Aikaikkuna: Within 140 days (inclusive) post-randomization
|
All-cause mortality |
Within 140 days (inclusive) post-randomization
|
|
All-cause hospitalization
Aikaikkuna: Within 140 days (inclusive) post randomization
|
All-cause hospitalization |
Within 140 days (inclusive) post randomization
|
|
Major adverse cardiovascular event
Aikaikkuna: Within 140 days (inclusive) post randomization
|
Composite of all-cause mortality, recurrent MI, unstable angina, stroke, TIA, or heart failure hospitalization |
Within 140 days (inclusive) post randomization
|
|
Change in EuroQol 5-Dimension 5-Level questionnaire Visual Analogue Scale
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Self-rated health using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Visual Analog Scale (VAS) ranging from 0 to 100, where 0 represents the worst imaginable health state and 100 represents the best imaginable health state. Higher scores indicate better perceived health |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in Seattle Angina Questionnaire - 7
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Angina-related health status measured using the Seattle Angina Questionnaire-7 (SAQ-7), a validated 7-item instrument assessing three domains: physical limitation, angina frequency, and quality of life. Scores are transformed to a 0-100 scale, where higher scores indicate better health status (fewer angina symptoms and less functional limitation). |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in FRAIL Scale Score
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Frailty status measured using the FRAIL Scale, a 5-item questionnaire assessing Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight. Scores range from 0 to 5, with 0 indicating robust, 1-2 indicating prefrail, and 3-5 indicating frail. Higher scores indicate greater frailty (worse health status). |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in PROMIS Physical Function Score
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Physical function measured using the PROMIS (Patient-Reported Outcomes Measurement Information System) Physical Function Short Form 10a (PROMIS PF 10a). Raw scores are converted to T-scores with a mean of 50 and standard deviation of 10, based on the U.S. general population. Higher scores indicate better physical function. |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in PROMIS Fatigue Score
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Fatigue measured using the PROMIS (Patient-Reported Outcomes Measurement Information System) Fatigue Short Form 4a (PROMIS Fatigue 4a). Raw scores are converted to T-scores with a mean of 50 and standard deviation of 10, based on the U.S. general population. Higher scores indicate greater fatigue (worse outcome). |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in PROMIS Depression Score
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Depression measured using the PROMIS (Patient-Reported Outcomes Measurement Information System) Depression Short Form 4a (PROMIS Depression 4a). Raw scores are converted to T-scores with a mean of 50 and standard deviation of 10, based on the U.S. general population. Higher scores indicate greater depressive symptoms (worse outcome). |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Change in Rose Dyspnea Scale
Aikaikkuna: Measured at baseline and between 140 to 154 days post-randomization
|
Dyspnea measured using the Rose Dyspnea Scale, a scale assessing shortness of breath. Scores range from 0 (no dyspnea) to 4 (dyspnea on minimal exertion or at rest). Higher scores indicate more severe dyspnea (worse outcome). |
Measured at baseline and between 140 to 154 days post-randomization
|
|
Number of Participants Who Are Current Smokers
Aikaikkuna: Assessed between 140 to 154 days post randomization
|
Currently/actively smoking. |
Assessed between 140 to 154 days post randomization
|
|
Number of Participants Taking Aspirin
Aikaikkuna: Assessed between 140 to 154 days post randomization
|
Aspirin use assessed via self-report and/or medication records at follow-up |
Assessed between 140 to 154 days post randomization
|
|
Number of Participants Taking a Statin
Aikaikkuna: Assessed between 140 to 154 days post randomization
|
Statin use assessed via self-report and/or medication records at follow-up. |
Assessed between 140 to 154 days post randomization
|
|
Adverse Events of Special Interest
Aikaikkuna: Occurring during or within 1 hour of participation in an exercise cardiac rehabilitation session up to 140 days post randomization.
|
These include:
|
Occurring during or within 1 hour of participation in an exercise cardiac rehabilitation session up to 140 days post randomization.
|
Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Yhteistyökumppanit
Yhteistyökumppanit
Tutkijat
Tutkijat
- Päätutkija: Cian P McCarthy, MB, BCh, BAO, SM, Massachusetts General Hospital
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Opiskelun aloitus
Ensisijainen valmistuminen (Arvioitu)
Ensisijainen valmistuminen
Opintojen valmistuminen (Arvioitu)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- 2026P000632
- 5K23HL167659 (Yhdysvaltain NIH-apuraha/sopimus)
Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
IPD-suunnitelman kuvaus
De-identified data generated from this study will be submitted to a data repository in accordance with NIH data sharing guidelines.
IPD-jaon aikakehys
Anticipated to be available at the time of publication of the study results.
IPD-jakamista tukeva tietotyyppi
- STUDY_PROTOCOL
- ICF
Lääke- ja laitetiedot, tutkimusasiakirjat
Tutkii yhdysvaltalaista FDA sääntelemää lääkevalmistetta
Tutkii yhdysvaltalaista FDA sääntelemää laitetuotetta
Nämä tiedot haettiin suoraan verkkosivustolta clinicaltrials.gov ilman muutoksia. Jos sinulla on pyyntöjä muuttaa, poistaa tai päivittää tutkimustietojasi, ota yhteyttä register@clinicaltrials.gov. Heti kun muutos on otettu käyttöön osoitteessa clinicaltrials.gov, se päivitetään automaattisesti myös verkkosivustollemme .