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Multicenter Study
. 2025 Sep 2;14(17):e040711.
doi: 10.1161/JAHA.124.040711. Epub 2025 Aug 22.

Human-Centered Design to Tailor Telehealth Cardiac Rehabilitation to Diverse Populations: The MCNAIR Study

Rae Denise Oanesa  1 , Namratha Atluri  2 , Alisa Boyd  1 , Shireen R Khoury  3 , Vanessa Legeza  4 , J Greg Merritt  5   6 , Patricia McNair  6 , Sonali R Mishra  7 , Mattheus Ramsis  8 , Erin M Spaulding  9   10   11 , LaPrincess C Brewer  12   13 , Daniel Edward Forman  4   14   15   16 , Jessica R Golbus  7 , Seth S Martin  3 , Brahmajee K Nallamothu  7 , Alexis L Beatty  1   17
Affiliations
Multicenter Study

Human-Centered Design to Tailor Telehealth Cardiac Rehabilitation to Diverse Populations: The MCNAIR Study

Rae Denise Oanesa et al. J Am Heart Assoc. .

Abstract

Background: Although telehealth cardiac rehabilitation (CR) may improve access, there are concerns about its long-term effectiveness and impact on equity as compared with in-person CR. Our objective was to tailor a patient-centered telehealth CR program for diverse populations.

Methods: CR patients and caregivers were recruited between January and September 2023 from 4 US academic medical centers. Participants engaged in human-centered design sessions to iteratively refine a telehealth CR program. Sessions had planned topics, but there was variation across sites to account for site-specific needs and participant feedback. Sessions were qualitatively analyzed using rapid template analysis with preselected behavioral science constructs and other emergent codes.

Results: The study included 21 participants (71% aged ≥60 years, 48% women, 62% non-Hispanic White individuals; 90% CR patients, 10% CR caregivers). Participants thought that telehealth CR could be helpful for personalized support at home and convenience but recognized that technology is not always easy to use. Some expressed concerns about the safety of telehealth CR, especially at the beginning, and desired monitoring through a mobile device or video observation of exercise. Safety protocols and technology training were developed, which addressed concerns about telehealth CR. Opportunities for social support with telehealth CR were also desired. From these findings, an implementation toolkit was developed, including a graphic program description, safety plan, home exercise plan for during and after CR, and scripts for technology training and individual and group telehealth visits.

Conclusions: A patient-centered telehealth CR program and implementation toolkit were systematically tailored to address the needs of diverse populations.

Keywords: cardiac rehabilitation; equity; implementation science; telehealth.

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Conflict of interest statement

Dr Martin reports additional research support from the American Heart Association Health Technologies and Innovation Strategically Focused Research Network (20SFRN35380046 and 20SFRN35490003), a collaborative project of this network (878924), additional support from the American Heart Association (882 415 and 946 222), the National Institutes of Health (P01 HL108800 and R01AG071032), the David and June Trone Family Foundation, the Pollin Digital Innovation Fund, Sandra and Larry Small, Google, and Merck. Dr Martin also reports receiving equity from Corrie Health; material support from Apple; grants from Google; serving on the Care Access advisory board (unpaid); and personal fees for consulting from Amgen, Arrowhead, AstraZeneca, Bristol Myers Squibb, Chroma, Heartflow, Kaneka, NewAmsterdam Pharma, Novartis, Novo Nordisk, Premier, Sanofi, and 89bio outside the submitted work.

Dr Spaulding reports additional research support from the American Heart Association (20SFRN35380046 and 878924) and the National Institutes of Health (U01HL096812) and personal consulting fees from Corrie Health.

Dr. Golbus receives funding from the National Institutes of Health (L30HL143700 and 1K23HL168220).

Dr Nallamothu is a principal investigator or coinvestigator on research grants from the National Institutes of Health, Veterans Affairs Health Services Research and Development, and the American Heart Association. He also receives compensation as editor‐in‐chief of Circulation: Cardiovascular Quality & Outcomes, a journal of the American Heart Association. Finally, he is a coinventor on US Utility Patent Number US15/356012 (US20170148158A1) entitled “Automated Analysis of Vasculature in Coronary Angiograms” that uses software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight, Inc., in which Dr Nallamothu holds ownership shares and receives consultancy fees.

All other authors have no disclosures to report.

Figures

Figure 1
Figure 1. Participant user journey for telehealth CR.
This represents a hypothetical participant journey for telehealth CR. This was presented to participants as part of the human‐centered design process and iteratively revised. Participants are referred to CR from the hospital or clinic, then attend an intake session at the CR center. Participants are offered an optional mobile application. Participants engage in a weekly individual telehealth session by video or phone with a CR professional. Participants are expected to exercise on their own. Group telehealth visits and sessions with other CR professions (eg, dietitian, pharmacist, behavioral health) are also available. If participants need to attend an in‐person CR session for safety, exercise prescription, or other reasons, they may attend in‐person CR sessions. At the completion of the 12‐week program, participants attend a graduation at the CR center.
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References

    1. AACVPR , ed. Guidelines for Cardiac Rehabilitation Programs. Sixth. Human Kinetics; 2021.
    1. Beatty AL, Truong M, Schopfer DW, Shen H, Bachmann JM, Whooley MA. Geographic variation in cardiac rehabilitation participation in medicare and veterans affairs populations: opportunity for improvement. Circulation. 2018;137:1899–1908. doi: 10.1161/CIRCULATIONAHA.117.029471 - DOI - PMC - PubMed
    1. Ritchey MD, Maresh S, McNeely J, Shaffer T, Jackson SL, Keteyian SJ, Brawner CA, Whooley MA, Chang T, Stolp H, et al. Tracking cardiac rehabilitation participation and completion among medicare beneficiaries to inform the efforts of a national initiative. Circ Cardiovasc Qual Outcomes. 2020;13:e005902. doi: 10.1161/CIRCOUTCOMES.119.005902 - DOI - PMC - PubMed
    1. Park LG, Schopfer DW, Zhang N, Shen H, Whooley MA. Participation in cardiac rehabilitation among patients with heart failure. J Card Fail. 2017;23:427–431. doi: 10.1016/j.cardfail.2017.02.003 - DOI - PMC - PubMed
    1. Sun EY, Jadotte YT, Halperin W. Disparities in cardiac rehabilitation participation in the United States: a SYSTEMATIC REVIEW AND META‐ANALYSIS. J Cardiopulm Rehabil Prev. 2017;37:2–10. doi: 10.1097/HCR.0000000000000203 - DOI - PubMed

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