Understanding and addressing risks of low socioeconomic status and diabetes for heart failure

了解和解决低社会经济地位和糖尿病导致心力衰竭的风险

• 批准号: 10437340
• 负责人: Chiadi E Ndumele
• 金额: $ 69.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437340
• 关键词: Address; African American; Ambulatory Care; Behavior Therapy; Clinical; Communities; Community Health; Community Health Aides; Complications of Diabetes Mellitus; Computerized Medical Record; Data; Diabetes Mellitus; Education; Educational Intervention; Evaluation; Feedback; Fibrosis; Functional disorder; Geography; Glycosylated hemoglobin A; Guidelines; Health system; Heart Injuries; Heart failure; Impairment; Individual; Intervention; Latino; Life Style; Link; Minority Groups; Morbidity - disease rate; Myocardial dysfunction; Native Americans; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Persons; Physical activity; Physiological; Population; Prevention; Problem Solving; Prognosis; Public Health; Quality of life; Randomized Controlled Trials; Resources; Risk; Risk Factors; Rural; Self Management; Socioeconomic Status; Structure; Support System; Target Populations; Testing; Training; Visit; Work; barrier to care; base; cardiometabolism; cardiorespiratory fitness; clinical risk; community based participatory research; cost; dietary; ethnic minority population; evidence base; experience; fitness; functional status; health care availability; health disparity; health equity; healthy lifestyle; improved; improved outcome; interest; low socioeconomic status; member; mortality; neighborhood association; prevent; preventive intervention; primary outcome; prognostic; programs; racial and ethnic; racial minority; randomized trial; rural setting; social health determinants; suburb; support network; urban setting

Summary Heart failure (HF) is associated with high morbidity, mortality and costs, and there is great interest in refining strategies to reduce HF risk. Diabetes (DM) and low socioeconomic status (SES) are each independent risk factors for HF, and both factors together have a synergistic association with incident HF. A major functional consequence of these associations is impaired cardiorespiratory fitness, with implications for prognosis and quality of life. Additionally, low SES and DM are over-represented among racial and ethnic minorities and therefore a cause of HF disparities. Strategies to address the high HF risk associated with the combination of low SES and DM will require a focus on social determinants of health. Problem-solving training and community health worker (CHW) support are effective in overcoming barriers to care, and improving lifestyle, DM self- management, health system engagement and risk factor control, but they have not yet been applied to addressing HF risk. Prevention efforts would be further informed by understanding geographic disparities in HF risk and elucidating clinical risk factors that might serve as targets for intervention. We therefore propose a randomized trial among 350 persons with low SES, DM, obesity and early cardiac dysfunction, testing the effects of a multi-level intervention of problem-solving training, CHW support and partnership with community facilities to support lifestyle change on fitness, risk factor control, markers of cardiac injury/fibrosis and quality of life. We propose: Aim 1: To use electronic medical record data to a) compare the association of neighborhood SES with incident HF in patients with DM, across urban, rural and suburban settings, and b) to identify modifiable clinical risk factors for HF associated with DM that are more prevalent in persons with low SES. Aim 2: To adapt an evidence-based, pragmatic intervention to improve functional status and risk factor control in persons with low SES, DM, obesity and early cardiac dysfunction, using community-based participatory research (CBPR) and patient-centered outcomes research (PCOR) principles. Aim 3: To test, in a randomized controlled trial, if a 1-year multilevel intervention of problem-solving training, CHW use to enhance social support and health system engagement, and use of community facilities to support lifestyle change improves cardiorespiratory fitness and related outcomes in those with low SES, DM, obesity and early cardiac dysfunction, more than enhanced education and connection with community health programs. This work will elucidate strategies to address HF risk related to low SES and DM, which are key contributors to HF disparities.

概括 心力衰竭（HF）与高发病率，死亡率和成本相关，并且对精炼非常感兴趣 降低HF风险的策略。糖尿病（DM）和低社会经济地位（SES）都是独立的风险 HF的因素以及两个因素共同与入射HF具有协同关联。主要功能 这些关联的后果是心肺健康受损，对预后和 生活质量。此外，在种族和少数民族中，低SES和DM的代表性过高 因此，HF差异的原因。解决与组合相关的高HF风险的策略 低SES和DM将需要关注健康的社会决定因素。解决问题的培训和社区 卫生工作者（CHW）的支持有效克服护理障碍和改善生活方式，DM自我 管理，卫生系统参与和风险因素控制，但尚未应用于 解决HF风险。通过了解HF的地理差异，将进一步告知预防工作 风险和阐明可能是干预目标的临床风险因素。因此，我们建议 SES，DM，肥胖和早期心脏功能障碍的350人中的随机试验，测试 多层干预解决问题的培训，CHW支持和与社区的伙伴关系的影响 支持健身，危险因素控制，心脏损伤/纤维化标志和质量的改变生活方式的设施 生活。我们建议：目标1：使用电子病历数据与a）比较 DM患者，城市，农村和郊区环境的患者的邻域SES b）确定与DM相关的HF的可修改临床危险因素，这些因素在 SES低的人。目标2：调整基于证据的务实干预以改善 SES，DM，肥胖症和早期心脏的人的功能状态和风险因素控制 功能障碍，使用基于社区的参与性研究（CBPR）和以患者为中心的结果 研究（PCOR）原理。目标3：在一项为期1年的多级试验中测试，在随机对照试验中测试 干预解决问题的培训，CHW用于增强社会支持和卫生系统 参与和使用社区设施来支持生活方式改变可改善心肺 SES，DM，肥胖和早期心脏功能障碍的健康状况和相关结果，更多 而不是加强教育和与社区卫生计划的联系。这项工作将阐明 解决与低SES和DM有关的HF风险的策略，这是HF差异的关键因素。