Mindfulness-Based Stress Reduction as an Adjunct Intervention to Cardiac Rehabilitation: A Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 47
- 试验地点
- 2
- 主要终点
- Change (improvement) in heart rate variability (HRV).
研究概览
简要总结
The guideline-recommended standard of care for patients who have experienced a heart attack, heart failure, or other coronary event or procedure is exercise-based cardiac rehabilitation (CR). Despite proven benefits, traditional CR is severely underutilized. Moreover, what is typically lacking from traditional CR programs is effective psychosocial risk management. This represents a critical gap in care given the well-documented psychosocial needs of this patient population.The objective of this feasibility study is to conduct a pilot randomized controlled trial (RCT) of Mindfulness-Based Stress Reduction (MBSR) versus usual care in CR-eligible cardiac patients. Randomization will be stratified within two strata based on participation in CR (yes/no) among CR-eligible patients. The primary goals of this pilot study are to: 1) obtain estimates of treatment effects and variability; 2) evaluate recruitment and retention strategies; and 3) examine the safety of the MBSR protocol in CR-eligible patients.
详细描述
Objectives:
The objective of this feasibility study is to conduct a pilot randomized controlled trial (RCT) of Mindfulness-Based Stress Reduction (MBSR) versus usual care in CR-eligible cardiac patients. Randomization will be stratified within two strata based on participation in CR (yes/no) among CR-eligible patients. The primary goals of this pilot study are to: 1) obtain estimates of treatment effects and variability; 2) evaluate recruitment and retention strategies; and 3) examine the safety of the MBSR protocol in CR-eligible patients.
Design and Outcomes:
The study design is a randomized controlled trial with randomization in two strata. The primary outcome will be a change (improvement) in heart rate variability (HRV) as assessed by a 24-hour Holter monitor worn by patients three times throughout the study: (pre- and post-intervention and 9-month follow-up). Time domain variables SDNN (the standard deviation of R-to-R intervals and RMSSD (the root mean square of successive differences in adjacent R-to-R intervals will be assessed. Time domain variables will be assessed via 24-hour Holter monitoring at baseline, 3-month follow-up and 9-month follow-up. HRV is a well-established method to assess the autonomic nervous system. Secondary outcomes will include psychosocial measures (depressive symptoms, mentally unhealthy days, stress, and anxiety) as well as cardiovascular risk factors (systolic blood pressure, body mass index, high density lipoprotein cholesterol, triglycerides, hemoglobin A1C, and c-reactive protein). All participants will undergo a baseline assessment, followed by randomization to the treatment or control condition, and three follow-up assessments, at 3, 6, and 9 months after randomization. The 3-month follow-up will occur immediately post-intervention and the 9-month follow up will occur 6-months post-intervention. The baseline, 3-month and 9-month (final) follow-up assessments will be in-person and will include questionnaires on stress and emotions, quality of life, a short physical performance battery, a blood draw to assess lipids, high sensitivity C-Reactive Protein and hemoglobin A1c as well as the 24-hour Holter monitor to assess HRV. The 6-month follow-up assessment will be by telephone only and include brief assessments of moods, stress, and symptoms. The investigators anticipate the pilot study will be completed in 18 months.
Interventions and Duration:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 21 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men and women age 21 and older that are medically eligible and been referred for traditional exercise-based CR (heart attack within the past 12 months, open heart surgery such as coronary bypass/valve/heart transplant, coronary angioplasty or stent placement, current stable angina, or heart failure)
- •Willing to participate in all assessments and be randomized to either study condition
- •Able to give informed consent.
排除标准
- •Has a cardiac pacemaker and is pacemaker-dependent or has an untreated atrial arrhythmia;
- •Previously completed an MBSR course;
- •Unable to read and write in English
结局指标
主要结局
Change (improvement) in heart rate variability (HRV).
时间窗: 0-9 months
Time domain and frequency domain variables will be assessed via 24-hour Holter monitoring at baseline, 3-month follow-up and 9-month follow-up. HRV is a well-established method to assess the autonomic nervous system, and has been shown to be a predictor of hard outcomes in cardiac patients. Given the deranged autonomic milieu in these patients, HRV is an appropriate surrogate end point for improved outcomes in this cohort.
次要结局
- Psychosocial function(0-9 months)
- Cardiovascular risk factors: C-reactive protein (CRP), lipids, hemoglobin A1c (HgA1c)(0-9 months)
- Physical functioning(0-9 months)