Home-Based Cardiac Rehabilitation for Patients With Heart Failure

Inclusion criteria

• Roll-in Phase
• Stage C HF (NYHA Class I-III) AND
• Discharged from a HF hospitalization OR
• Scheduled for appointment in a cardiology clinic with a prior HF hospitalization within the past 12 months OR
• Scheduled for appointment in a cardiology clinic with a KCCQ-SS \<75
• Receives longitudinal HF care at VUMC, including at least one visit prior to the roll-in phase Randomized Controlled Trial (beyond roll-in phase) 1\. Willingness to continue and participate in the study visits and other study activities required for the RCT

Exclusion criteria

• Roll-in Phase
• Unwilling or unable to provide informed consent for participation in the RCT
• Requires a wheelchair all (or most) of the time inside and outside the house; it is acceptable if a wheelchair is needed, for example, for parking lot transfer for a clinic visit and navigating around the hospital without it being needed in the home
• If an individual uses a walker or cane all (or most) of the time, then he/she will be excluded if he/she scores 2 or lower on the Mini-Cog or the patient is unable to perform 2 chair sit-to-stands independently or is deemed to be at high fall risk during baseline visit assessment.
• History of falls over the last 6 months; an isolated explainable fall with no injury would not exclude the patient, but a tendency to falls indicative of balance/stability issues would exclude the patient.
• Age \< 18 years
• Stage D HF (advanced HF under evaluation for LVAD or transplant)
• NYHA class IV symptoms
• Congenital heart disease
• Group 1 pulmonary hypertension
• Moderate-severe or severe (\> 3+) mitral or aortic valvular disease
• Physical or neuropsychiatric limitations that would prevent proficient use of the study tools and successful completion of the physical and quality of life assessments (e.g. blindness, dementia)
• Planned surgery within 3 months
• Planned discharge from hospital to hospice, assisted living, or inpatient rehabilitation facility (discharge to a senior facility permitted as long as they are considered Independent Living)
• Treating provider or study team physician indicates that participation in the RCT would be unsafe
• Participation in any ongoing randomized trial that has not completed follow-up Randomized Controlled Trial (beyond roll-in phase)
• Not adherent to wearing the Actigraph activity tracker during the roll-in phase for a minimum of 4 (out of 10) compliant days (worn ³10 hours/day). Allowance will be made to include participants who wear the ActiGraph device ³10 hours/day for 3 days and also wear the ActiGraph device \>9 hours/day for at least 1 day.
• Unable to complete the baseline study visit within 4 weeks of the completion of the roll-in actigraphy assessment.