Transition to Cardiac Rehabilitation (T2CR) to Address Barriers of Multimorbidity and Frailty

Cardiac rehabilitation (CR) is a secondary prevention program for patients with cardiovascular disease (CVD). It is especially valuable as CVD increasingly occurs in combination with comorbidity, frailty, and complexities of care that predispose patients to functional decline, disability, and high costs. Still, few Veterans participate in CR, in part because of the difficult logistics to attend. Promising Practice home-based CR (HBCR) was developed to increase CR participation, but many Veterans remain too limited by comorbidity and frailty for participation. A Transition to CR (T2CR) intervention is a face-to-face program that fosters vital skills, education, insights, motivation, and patient-provider relationships conducive to successful HBCR thereafter. This study compares Veterans eligible for CR who are randomized to T2CR intervention versus usual care. Differences in functional capacity, HBCR participation, and healthy days at home are compared over one year. Patients' experiences and providers' perspectives of barriers and facilitators to T2CR are also compared.

Inclusion Criteria: * Eligible candidates will consist of male and female Veterans hospitalized with: * ischemic heart disease (acute myocardial infarction or stable ischemia) * revascularization (coronary artery bypass grafting or percutaneous coronary intervention) * valvular heart disease (surgical or percutaneous intervention for mitral regurgitation or aortic stenosis) * or heart failure (with reduced or preserved ejection fraction) * All will be recruited while initially hospitalized and must express willingness to consider cardiac rehabilitation as a treatment option, including the possibility of the intervention which could possibly extend the length of their hospitalization (for 2 days maximum) * Study candidates must also be English speaking and able to provide written informed consent Exclusion Criteria: * Veterans with unstable medical condition as indicated by history, physical exam, and/or laboratory findings end-stage disease likely to be fatal within 12 months * Severe cognitive impairment (MiniCog score 0-2) * History of addictive or behavioral issues that confound safe administration of home-based cardiac rehabilitation (HBCR) * Hearing loss that interferes with participation in the trial * Living in a long-term care living situation prior to the time of hospitalization, no plans to return to independent living after the hospitalization