Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial
Creators: name: Steinmetz, Carolin
name: Heinemann, Stephanie
name: Kutschka, Ingo
name: Hasenfuß, Gerd
name: Asendorf, Thomas
name: Remppis, Bjoern Andrew
name: Knoglinger, Ernst
name: Grefe, Clemens
name: Albes, Johannes Maximilian
name: Baraki, Hassina
name: Baumbach, Christian
name: Brunner, Susanne
name: Ernst, Susann
name: Harringer, Wolfgang
name: Heider, Dirk
name: Heidkamp, Daniela
name: Herrmann-Lingen, Christoph
name: Hummers, Eva
name: Kocar, Thomas
name: König, Hans-Helmut
name: Krieger, Simone
name: Liebold, Andreas
name: Martens, Andreas
name: Matzeder, Marcus
name: Mellert, Friedrich
name: Müller, Christiane
name: Puls, Miriam
name: Reiss, Nils
name: Schikora, Martin
name: Schmidt, Thomas
name: Vestweber, Martin
name: Sadlonova, Monika
name: Von Arnim, Christine A. F.
name: PRECOVERY Investigators
Publisher: name: Universität Ulm
Year: 2023
Subjects: subject: Prehabilitation
subject: Preoperative preparation
subject: Cardiac procedure
subject: Older patients
subject: Preoperative exercise
subject: Randomized controlled trial
subject: Medical and Health Sciences
subject: DDC 610 / Medicine &amp; health

description: Abstract Background Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients’ pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors. Methods In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention. Discussion In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients. Trial registration German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00030526). Registered on 30 January 2023.