The Effect of Peer-Mentor Support for Older Vulnerable Patients With Ischemic Heart Disease—A 24-Week Randomized Controlled Trial

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Abstract
Background: The positive effects of cardiac rehabilitation (CR) are well established; however, among older and vulnerable patients, nonattendance and dropout are prevalent problems. Aim: The objective of this study is to explore if a 24-week peer-mentor intervention increases initial and long-term CR attendance. Secondary aims are whether peer-mentor intervention improves lifestyle (diet and physical activity) and psychological outcomes (self-efficacy, anxiety, depression, and quality of life) among older vulnerable patients with ischemic heart disease. Methods: The study was designed as a 2-arm, single-center, parallel, 24-week, randomized controlled trial (RCT) with follow-up at 12 and 24 weeks. Patients were randomized at a ratio of 1:1 to receive either the peer-mentor intervention (in addition to standard CR) or standard CR along (control arm). Results: Between August 2021 and March 2023, 117 older, vulnerable patients were enrolled and randomized (59 randomized to peer-mentor intervention and 58 to usual care). The peer-mentor intervention significantly increased CR attendance. This applies to both initial participation in 1 CR session of physical training or dietary advice (78.0% vs 58.6%; P = .03), and long-term attendance in ≥50% dietary advice sessions (50.8% vs 27.6%; P = .01) and completed ≥50% (64.4% vs 41.4% P = .01) or ≥75% of the physical training sessions (59.3% vs 37.9%; P = .02). The study found no statistically significant effect on secondary outcomes. Conclusions: Low CR attendance is a well-known problem, especially among older, vulnerable patients; however, we tested a low-cost, peer-mentor intervention that significantly increased both initial CR participation and long-term attendance in CR sessions in this group of patients.

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