{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:45:24Z","timestamp":1785422724722,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2014Next Generation EU\u2014NRRP M6C2\u2014Investment 2.1 Enhancement and strengthening of biomedical research in the NHS","award":["PNRR-MAD-2022-12376806"],"award-info":[{"award-number":["PNRR-MAD-2022-12376806"]}]},{"award":["PNRR-MAD-2022-12376806"],"award-info":[{"award-number":["PNRR-MAD-2022-12376806"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and strongly predicts disability and mortality after cardiac events. Although cardiac rehabilitation (CR) improves prognosis, frail older patients often face barriers to participating in in-person programs. eHealth-based, home-delivered CR programs incorporating tele-rehabilitation and remote monitoring may improve accessibility, yet evidence regarding their effectiveness on frailty status remains limited. Methods: We designed a multicenter, randomized, parallel-group trial enrolling people \u226565 years recently hospitalized for acute heart failure (AHF) and\/or acute coronary syndrome (ACS). Participants were randomized 1:1 to an eHealth home-based tele-rehabilitation program or the usual care. The primary endpoint is frailty prevalence at follow-up, defined by an Essential Frailty Toolset (EFT) score \u22653, with co-primary outcomes being between-group differences in the mean levels of EFT and Short Physical Performance Battery (SPPB) scores after 3\u20136 months. Secondary endpoints include mortality and hospitalization, among others. Results: The full protocol and study procedures are reported. Between May 2024 and December 2025, 589 patients were screened at the two Italian centers involved; 442 met eligibility criteria and 209 were enrolled and randomized. Baseline characteristics were largely comparable between groups. The mean age was 77 \u00b1 9 years, 70% were male, and 55% had ACS. Lower-than-expected enrollment was mainly attributable to refusal related to difficulties in using digital devices. Conclusions: This randomized trial will evaluate whether a multidomain, eHealth-based CR intervention can reduce the prevalence or degree of frailty in older people after AHF or ACS. We report the study protocol and baseline characteristics of the enrolled cohort, highlighting the challenge of digital illiteracy in contemporary older populations.<\/jats:p>","DOI":"10.3390\/jcm15072573","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:33:33Z","timestamp":1774622013000},"page":"2573","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness on Frailty of an eHealth-Based Rehabilitation Program in Older People with Acute Heart Failure and\/or Acute Coronary Syndrome: Study Protocol for a Randomized Trial and Baseline Data of Participants"],"prefix":"10.3390","volume":"15","author":[{"given":"Gaia","family":"Cattadori","sequence":"first","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Section of Cardiology, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto F. E.","family":"Pedretti","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Sarzi Braga","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele Maria","family":"Maglio","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mancino","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Staine","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mondaini","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Eramo","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1187-5296","authenticated-orcid":false,"given":"Valeria","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2224-4615","authenticated-orcid":false,"given":"Rosalba","family":"La Grotta","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Bruno","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eros","family":"Patuzzo","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1840-3903","authenticated-orcid":false,"given":"Giulia","family":"Matacchione","sequence":"additional","affiliation":[{"name":"Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8477-8519","authenticated-orcid":false,"given":"Angelica","family":"Giuliani","sequence":"additional","affiliation":[{"name":"Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy"},{"name":"Department of Clinical and Molecular Sciences, Universita Politecnica Delle Marche, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Carbonara","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ferrulli","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1235-6157","authenticated-orcid":false,"given":"Maria","family":"Venneri","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Osella","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucrezia","family":"Quarto","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Genco","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"D\u2019Addabbo","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Camicia","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6221-734X","authenticated-orcid":false,"given":"Lucia","family":"Palazzo","sequence":"additional","affiliation":[{"name":"Bioengineering Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio","family":"Caruso","sequence":"additional","affiliation":[{"name":"Bioengineering Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9718-1658","authenticated-orcid":false,"given":"Liana","family":"Spazzafumo","sequence":"additional","affiliation":[{"name":"Scientific Direction, IRCCS INRCA, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9606-1144","authenticated-orcid":false,"given":"Fabiola","family":"Olivieri","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Sciences, Universita Politecnica Delle Marche, 60100 Ancona, Italy"},{"name":"Biogerontology Center and Geriatric Mouse Clinic, IRCCS INRCA, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8153-2599","authenticated-orcid":false,"given":"Elena","family":"Tagliabue","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2959-2658","authenticated-orcid":false,"given":"Francesco","family":"Prattichizzo","sequence":"additional","affiliation":[{"name":"IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-576X","authenticated-orcid":false,"given":"Andrea","family":"Passantino","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit of Bari Institute, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/ggi.12190","article-title":"Frailty as a predictor of all-cause mortality in older men and women","volume":"14","author":"Kulmala","year":"2014","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Buurman, B.M., Hoogerduijn, J.G., de Haan, R.J., Abu-Hanna, A., Lagaay, A.M., Verhaar, H.J., Schuurmans, M.J., Levi, M., and de Rooij, S.E. (2011). Geriatric conditions in acutely hospitalized older patients: Prevalence and one-year survival and functional decline. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026951"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.jacc.2021.11.029","article-title":"Interventions for Frailty Among Older Adults with Cardiovascular Disease: JACC State-of-the-Art Review","volume":"79","author":"Ijaz","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/eurpub\/ckaa068","article-title":"The dynamics of frailty and change in socio-economic conditions: Evidence for the 65+ in Europe","volume":"30","author":"Sirven","year":"2020","journal-title":"Eur. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 Update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.tcm.2022.01.015","article-title":"The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: A framework","volume":"33","author":"Scherrenberg","year":"2023","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1177\/0733464820983630","article-title":"The Effect of Telehealth Interventions on Function and Quality of Life for Older Adults with Pre-Frailty or Frailty: A Systematic Review and Meta-Analysis","volume":"40","author":"Esfandiari","year":"2021","journal-title":"J. Appl. Gerontol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jacc.2017.06.024","article-title":"Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study","volume":"70","author":"Afilalo","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/s43587-021-00099-3","article-title":"The degree of frailty as a translational measure of health in aging","volume":"1","author":"Howlett","year":"2021","journal-title":"Nat. Aging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"glad244","DOI":"10.1093\/gerona\/glad244","article-title":"Vigor to Frailty As a Continuum-A New Approach in the Study of Muscle, Mobility, and Aging Cohort","volume":"79","author":"Newman","year":"2024","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e020219","DOI":"10.1161\/JAHA.120.020219","article-title":"The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery","volume":"10","author":"Solomon","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pavasini, R., Guralnik, J., Brown, J.C., di Bari, M., Cesari, M., Landi, F., Vaes, B., Legrand, D., Verghese, J., and Wang, C. (2016). Short Physical Performance Battery and all-cause mortality: Systematic review and meta-analysis. BMC Med., 14.","DOI":"10.1186\/s12916-016-0763-7"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1056\/NEJM199503023320902","article-title":"Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability","volume":"332","author":"Guralnik","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J. Gerontol."},{"key":"ref_15","unstructured":"(2026, February 03). Short Physical Performance Battery (SPPB), Available online: https:\/\/www.nia.nih.gov\/research\/resource\/short-physical-performance-battery-sppb."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An official European Respiratory Society\/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_17","first-page":"61","article-title":"Functional evaluation: The Barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0165-1781(92)90005-N","article-title":"Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale","volume":"41","author":"Miller","year":"1992","journal-title":"Psychiatry Res."},{"key":"ref_19","first-page":"15","article-title":"Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of older patients","volume":"4","author":"Vallas","year":"1994","journal-title":"Facts Res. Gerontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini Mental State\u201d a practical method for grading the cognitive state of patients for the clinicians","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_21","first-page":"165","article-title":"Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version","volume":"5","author":"Sheikh","year":"1986","journal-title":"Clin. Gerontol. J. Aging Ment. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/00005650-198601000-00007","article-title":"Concurrent and predictive validity of a self-reported measure of medication adherence","volume":"24","author":"Morisky","year":"1986","journal-title":"Med. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1093\/gerona\/glaa003","article-title":"Evaluation of Clinically Meaningful Changes in Measures of Frailty","volume":"75","author":"Jang","year":"2020","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_24","unstructured":"(2026, February 03). Cittadini e Competenze Digitali. Available online: https:\/\/www.istat.it\/it\/files\/2023\/06\/cs-competenzedigitali.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1001\/jama.2022.21506","article-title":"Adjustment for Baseline Characteristics in Randomized Clinical Trials","volume":"328","author":"Holmberg","year":"2022","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1007\/s00380-023-02254-9","article-title":"Predictors of physical frailty improvement in older patients enrolled in a multidisciplinary cardiac rehabilitation program","volume":"38","author":"Baldasseroni","year":"2023","journal-title":"Heart Vessels"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2573\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:06:24Z","timestamp":1775059584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072573"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072573","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}