BACKGROUND: Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults' uptake, and efficacy data are currently lacking. OBJECTIVE: This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. METHODS: RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged > /=65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). RESULTS: As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. CONCLUSIONS: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32163.

INTRODUCTION: While survival after acute myocardial infarction has improved substantially, older adults remain at heightened risk for poor hospital readmissions and death. Evidence for the role of cognitive impairment in older myocardial infarction survivors' risk for these outcomes is limited. METHODS: 3,006 patients age > /=75 hospitalized with acute myocardial infarction (mean age 82+/-5 years, 56% male) were recruited from 94 U.S. hospitals. Cognition was assessed using the Telephone Interview for Cognitive Status; scores of < 27 and < 22 indicated mild and moderate/severe impairment. Readmissions and death at six months post-discharge were ascertained via participant report and medical record review. Associations between cognitive and outcomes were evaluated with multivariable-adjusted logistic regression. RESULTS: Mild and moderate/severe cognitive impairment were present in 11% and 6% of the cohort. Readmission and death at six months occurred in 41% and 9% of participants. Mild and moderate/severe cognitive impairment were associated with increased risk of readmission (ORs=1.36, 95%CI 1.08-1.72 and 1.58, 95%CI 1.18-2.12, respectively) and death (ORs=2.19, 95%CI 1.54-3.11 and 3.82, 95%CI 2.63-5.56, respectively) in unadjusted analyses. Significant associations between moderate/severe cognitive impairment and death persisted after adjustment for demographics, myocardial infarction characteristics, comorbidity burden, functional status, and depression (OR=1.69, 95%CI 1.10-2.59), but not for readmissions. CONCLUSIONS: Moderate-to-severe cognitive impairment is associated with heightened risk of death in older acute myocardial infarction patients in the months after hospitalization, but not with readmission. Routine cognitive screening may identify older myocardial infarction survivors at risk for poor outcomes, who may benefit from closer oversight and support in the post-discharge period.