Key Points:
- Older adults have higher cardiovascular risk in conjunction with other comorbidities
- Cardiac rehab (CR) is an opportunity to improve health after major cardiovascular events, but multiple factors often limit participation
- The MACRO study investigated a coaching intervention in helping facilitate CR for older adults
- The study overall did not show increased physical function or activity, but a subgroup analysis demonstrated improved outcomes among highly compliant patients
Older patients have higher risk of cardiovascular disease as well as other comorbidities. Fortunately, cardiac rehab (CR) presents an opportunity to improve physical health after major cardiovascular events and subsequent hospitalizations. However, multiple core morbidities, frailty, and age related limitations often undercut physical function and participation in CR. the MACRO Study investigated the utility of using a coaching intervention to increase physical function through an enhanced transition to CR.
The MACRO study had two aims: 1) increase functional capacity by facilitating CR for older adults, and 2) assess duration of functional gains at 3, 6, and 12 months. This was a randomized controlled trial with participants allocated 1:1 to a coaching intervention vs standard care. Patients were at least 70 years old after an incident hospitalization for cardiovascular disease, including coronary artery disease (CAD), heart failure (HF), valvular heart disease (VHD), or peripheral artery disease (PAD) among three healthcare centers. The coaching intervention was three-pronged, including behavior modification through personalized goal-setting and progress tracking; risk assessment with integrated medical, functional, and psychosocial domains; and CR format tailored to risk and preferences, with a site-based, home-based, or a hybrid-CR option.
The study demonstrated 88% retention at 3 months and 77% retention at 12 months. Groups were well-balanced across variable characteristics, including age, gender, race, ethnicity, marital status, readiness to change, and frailty. Ultimately, the coaching intervention did not show significant increase in mobility (p=0.5430) or activity (p=0.9257) compared to standard of care. Likewise, the coaching intervention did not show overall significant change in secondary outcomes including change in Duke Activity Status Index (DASI) or frailty; however, in a subgroup analysis, highly compliant participants demonstrated improved outcomes with the coaching intervention compared to standard of care, with improved basic mobility at 3 months (p=0.0181), daily activity after 3 months (p=0.0472), and Duke Activity Status at 3, 6, and 12 months.
In summary, the MACRO study did not find that a coaching intervention significantly increased physical function or CR participation. However, the investigators did note a dose effect: among highly compliant patients, the coaching intervention did appear to be associated with positive outcomes. These results suggest further investigation into CR utilization among other considerations for improving post-acute cardiovascular care among older adults.