Peer-mentor Support for Older Vulnerable Myocardial Infarction Patients

Study Overview
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Brief Summary
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BACKGROUND: Advanced treatment regimens have reduced cardiovascular mortality resulting in an increasingly older myocardial infarction (MI) population in need of cardiac rehabilitation (CR) , the majority (74%) is above 60 years. The positive effect of CR is well established; CR reduces cardiovascular mortality, lowers hospital admissions, and improves quality of life among patients with ischemic heart disease. These positive effects of CR has also been established among older patients. The inherent problem lies in the low attendance rate, often below 50%. Several studies, including studies from Denmark, have shown that low participation in CR is most prevalent among older, vulnerable female patients. The notion vulnerable covers patients with low socioeconomic position (SEP), patients with non-western background and patients living alone, as these groups have particularly low CR attendance. Effective interventions aiming at increasing CR attendance among these low attending groups are thus warranted and the current study will seek to address this. AIM: To test feasibility and acceptability of methods used in a peer-mentor intervention among older female and vulnerable post MI patients. DESIGN AND METHODS: The study is designed as a one arm feasibility study. Patients (n=20) are recruited by a dedicated research nurse before discharge from the cardiology department at Nordsjællands Hospital. Data is collected at three timepoints, baseline, 12 weeks and 24 weeks. The patients (mentees) are matched with peer-mentors. Peer-mentoring (i.e. mentoring by a person with a similar life situation or health problem as one self) is a low-cost intervention that holds the potential to improve CR attendance and improve physical and psychological outcomes among older patients. Peer-mentors are role models who can guide and support patients overcoming barriers of CR attendance. Peer-mentoring is unexplored in a CR setting among older, female and vulnerable MI patients; establishing the novelty of the current study.

Official Title
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'HjertensGlad'.Inequality in Cardiac Rehabilitation Attendance: Peer-mentors as a Feasible Solution

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Other: Peer-mentoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥65 years and diagnosed with MI and referred to CR and female or low SEP or single living or non-western background. Exclusion Criteria: Patients unable to provide written consent.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Peer-mentoring<br>Peer-mentoring | Other: Peer-mentoring<br>* Patients (mentees) are matched with a peer-mentor. Throughout the intervention period (24 weeks), the mentee and the mentor will have informal telephone contact and meet face-to face approximately 8 times during the intervention period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recruitment | Number of patients included from eligible patients | Baseline | 
| Dropout | Number of patients not completing the intervention | 24 weeks | 
| Satisfaction with intervention | Semi-structured qualitative interviews with patients | 12 weeks | 
| Number of contacts | Number of contacts between patient and peer-mentor | 24 weeks | 
| Content of contacts | Content of contacts between patient and peer-mentor will be assessed through open ended question on questionnaire i.e. 'What was the content of your meeting? e.g face-to-face meeting with conversation about everyday life' | 24 weeks | 
| CR attendance | Measured as 'self-reported CR attendance' | 12 weeks | 
| CR attendance | Measured as 'self-reported CR attendance' | 24 weeks | 
| Change in Health-related Quality of Life | Measured using the 'HeartQoL' 'Health-related Quality of Life Questionnaire'. Min. score: 0, max score: 42. Higher scores indicating a better outcome. | Baseline to 24 weeks | 
| Change in Self-efficacy | Measured using the questionnaire 'General self-efficacy scale'. Min score: 10, max score: 40. Higher scores indicating a better outcome | Baseline to 24 weeks | 
| Change in symptoms of anxiety and depression | Measured using the questionnaire 'The hospital anxiety and depression scale' (HADS). Min. score: 0, max score 42. Lower scores indicating a better outcome | Baseline to 24 weeks | 
| Change in dietary quality | Measured using the questionnaire 'Heartdiet'. Higher scores indicating a better outcome | Baseline to 24 weeks | 
| Change in physical activity | Measured using the questionnaire 'Heartdiet'. Higher scores indicating a better outcome | Baseline to 24 weeks |