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臨床医のメッセージと動機付け通話による二次的心筋梗塞後の心臓リハビリテーション出席率向上 (ATTEND-CR)

2026年9月20日 更新者：McCarthy, Cian、Massachusetts General Hospital

二次的心筋梗塞後の心臓リハビリテーションへの参加を向上させるためのチームと患者の活性化（ATTEND-CR）試験

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

調査の概要

状態

募集

条件

介入・治療

詳細な説明

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.

研究の種類

介入

入学 (推定)

60

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

  • 名前：Cian McCarthy, MB, BCh, BAO, SM
  • 電話番号：617-726-2000
  • メール：CMCCARTHY37@MGB.ORG

研究連絡先のバックアップ

研究場所

  • アメリカ
    • Massachusetts
      • Boston、Massachusetts、アメリカ、02114
        • 募集
        • Massachusetts General Hospital
        • コンタクト：
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年歳以上 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

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

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：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.
行動：Clinician-level intervention

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.

行動：Patient-level intervention

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.
介入なし：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.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Number of Participants Who Attended one or more Cardiac Rehabilitation Exercise Session
時間枠：Within 140 days (inclusive) post-randomization

Attendance at one or more cardiac rehabilitation exercise session
Within 140 days (inclusive) post-randomization

二次結果の測定

結果測定
メジャーの説明
時間枠
Number of Participants With a Cardiac Rehabilitation Referral
時間枠：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
時間枠：Within 140 days (inclusive) post-randomization

Completion defined as attendance at ≥12 cardiac rehabilitation exercise sessions
Within 140 days (inclusive) post-randomization
Feasibility indicators
時間枠：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.
  1. Recruitment: Proportion of eligible patients randomized; threshold ≥40%.
  2. Retention: Proportion completing interim or final follow-up; threshold ≥70%.
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.

その他の成果指標

結果測定
メジャーの説明
時間枠
All-cause mortality
時間枠：Within 140 days (inclusive) post-randomization

All-cause mortality
Within 140 days (inclusive) post-randomization
All-cause hospitalization
時間枠：Within 140 days (inclusive) post randomization

All-cause hospitalization
Within 140 days (inclusive) post randomization
Major adverse cardiovascular event
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：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
時間枠：Assessed between 140 to 154 days post randomization

Currently/actively smoking.
Assessed between 140 to 154 days post randomization
Number of Participants Taking Aspirin
時間枠：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
時間枠：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
時間枠：Occurring during or within 1 hour of participation in an exercise cardiac rehabilitation session up to 140 days post randomization.

These include:

  • Major cardiovascular/cerebrovascular events (MI, unstable angina, stroke/TIA, death)
  • Clinically significant arrhythmia requiring medical treatment
  • Hemodynamic instability (exercise induced hypotension requiring medical treatment other than oral hydration, hypertensive emergency requiring medical treatment, syncope)
  • Acute decompensated heart failure
  • Exercise-related injuries or complications (falls resulting in injury requiring medical attention or treatment, non-fall exercise related injuries requiring medical attention or treatment, hypoglycemia requiring medical treatment, hypoxia (non-HF related) requiring medical treatment.
Occurring during or within 1 hour of participation in an exercise cardiac rehabilitation session up to 140 days post randomization.

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Massachusetts General Hospital

協力者

National Heart, Lung, and Blood Institute (NHLBI)

捜査官

  • 主任研究者：Cian P McCarthy, MB, BCh, BAO, SM、Massachusetts General Hospital

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年10月1日

一次修了 (推定)

2028年4月1日

研究の完了 (推定)

2028年4月1日

試験登録日

最初に提出

2026年3月12日

QC基準を満たした最初の提出物

2026年3月16日

最初の投稿 (実際)

2026年3月20日

学習記録の更新

投稿された最後の更新 (実際)

2026年9月23日

QC基準を満たした最後の更新が送信されました

2026年9月20日

最終確認日

2026年9月1日

詳しくは

本研究に関する用語

キーワード

その他の研究ID番号

  • 2026P000632
  • 5K23HL167659 (米国 NIH グラント/契約)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

De-identified data generated from this study will be submitted to a data repository in accordance with NIH data sharing guidelines.

IPD 共有時間枠

Anticipated to be available at the time of publication of the study results.

IPD 共有サポート情報タイプ

  • STUDY_PROTOCOL
  • ICF

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米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

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