Fatigue in Heart Failure: A Secondary Data Analysis of the Atherosclerosis Risk in Communities Study

心力衰竭引起的疲劳：社区研究中动脉粥样硬化风险的二次数据分析

• 批准号: 10464036
• 负责人: Noelle Victoria Pavlovic
• 金额: $ 4.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-08-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10464036
• 关键词: Address; Admission activity; Adult; Affect; Age; Annual Reports; Atherosclerosis; Atherosclerosis Risk in Communities; Body mass index; Cardiac; Cardiac Output; Cessation of life; Chronic Disease; Clinical; Complex; Congestive; Congestive Heart Failure; Data Analyses; Diagnostic tests; Disease; Disease Outcome; Distress; EFRAC; Exertion; Family; Fatigue; Foundations; Functional disorder; Funding; Future; Goals; Heart failure; Hospitalization; Individual; Intervention; Investigation; Knowledge; Lead; Left; Liquid substance; Literature; Measures; Modeling; Morbidity - disease rate; Muscle function; National Institute of Nursing Research; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Phenotype; Quality of life; Reporting; Research; Research Design; Risk; Risk Factors; Self Care; Self Management; Severities; Site; Skeletal Muscle; Socioeconomic Status; Strategic Planning; Structure; Symptoms; Syndrome; Testing; United States; United States National Institutes of Health; Ventricular; cardiovascular disorder risk; clinically relevant; common symptom; comorbidity; emotional functioning; empowered; epidemiology study; evidence base; experience; hospital readmission; improved; innovation; mortality; outcome prediction; preservation; prevent; prognostic; programs; prospective; provider intervention; psychologic; respiratory; sex; symptom management; symptom science

Project Summary Heart failure (HF) affects an estimated 6.2 million adults in the United States.1 Importantly, this debilitating syndrome causes significant morbidity and mortality with nearly 80,000 HF-related deaths reported annually.1 Fatigue is a prevalent and distressing symptom for patients with HF and evidence suggests that it has significant prognostic and outcome implications.2,3,4 The presence and increased severity of fatigue in HF increases the risk of hospitalization5,6 and mortality7,8 and is associated with increased depression3,4,9,10, poorer quality of life11,12, worse self-care13, and reduced physical14,15,3, social14, and emotional functioning.16 Fatigue in HF has been characterized in the literature as two types 1) general fatigue and 2) exertional fatigue. 1) general fatigue and 2) exertional fatigue. General and exertional fatigue and their co-occurrence are important to understand because their predictors and associated outcomes may differ. Accurate identification of fatigue type may lead to different interventions to alleviate that fatigue. However, little evidence examines patient reported and clinical outcome differences between general and exertional fatigue, clinically relevant predictors of fatigue have not been identified, and differences in the fatigue experience between HFrEF and HFpEF have not yet been explored. This creates a cap in our understanding of the risk factors for, and associated outcomes of fatigue type in HF. Using a secondary data analysis, this study aims to characterize fatigue types, quantify the relationship between fatigue type and clinical and patient reported outcomes, and examine the cardiac structural and functional predictors of fatigue type in those with HFrEF and HFpEF in the Atherosclerosis Risk in Communities (ARIC) study. This will be accomplished through the following specific aims: AIM 1: Define distinct types of fatigue in individuals with chronic heart failure. AIM 2: Quantify the longitudinal association between fatigue type and HF readmission and mortality and quantify the cross-sectional association between fatigue type and quality of life. AIM 3: Determine the cross-sectional relationship between measures of cardiac structure and function (left ventricular (LV) structure, LV systolic function, LV diastolic function), HF phenotype (HFrEF vs HFpEF), and fatigue type (adjusting for age, sex, socioeconomic status, BMI, comorbidities, and medications). This study will address critical evidence gaps and provide an evidence base for future research to prevent and mitigate the effects of fatigue in HF. It will lay the foundation for a future program of symptom science research investigating multi- dimensional models of HF fatigue symptom science. This study aligns with the National Institute of Nursing Research's strategic plan focus to advance knowledge in symptom science with the goal of developing and testing innovative interventions to alleviate suffering from symptoms and improve quality of life.

项目摘要 心力衰竭（HF）在美国影响约620万成年人。1重要的是，这种使人衰弱 综合征引起明显的发病率和死亡率，每年报告近80,000例HF相关死亡。1 对于HF患者而言，疲劳是一种普遍且令人不安的症状，证据表明它具有 2,3,4 HF疲劳的存在和严重程度增加 增加住院的风险为5,6和死亡率7,8，与抑郁症的增加有关3,4,9,10， 生活质量较差11,12，更糟的自我照顾和降低的物理14,15,3，社交14和情感功能。16 HF中的疲劳已在文献中被描述为两种类型1）一般疲劳和2）劳累疲劳。 1）一般疲劳和2）劳累疲劳。一般和劳累疲劳及其共发生 重要的是要理解，因为它们的预测因素和相关结果可能会有所不同。准确的 鉴定疲劳类型可能会导致不同的干预措施以减轻疲劳。但是，很少 证据检查了一般性疲劳和劳累疲劳之间报告的患者报告和临床结果差异， 尚未确定临床相关的疲劳预测指标，疲劳经验的差异 在HFREF和HFPEF之间尚未探索。这在我们对风险的理解中创造了一个上限 HF中疲劳类型的因素和相关结果。使用二级数据分析，本研究的目的 要表征疲劳类型，请量化疲劳类型与临床与患者之间的关系 报告的结果，并检查疲劳类型的心脏结构和功能预测指标 在社区（ARIC）研究中患有HFREF和HFPEF的人。这将是 通过以下特定目的完成：目标1：定义患有患者的不同类型的疲劳类型 慢性心力衰竭。目标2：量化疲劳类型与HF再入院之间的纵向关联 以及死亡率并量化疲劳类型和生活质量之间的横截面关联。目标3： 确定心脏结构和功能措施之间的横截面关系（左心室 （LV）结构，LV收缩功能，LV舒张功能），HF表型（HFREF与HFPEF）和疲劳类型 （调整年龄，性别，社会经济地位，BMI，合并症和药物）。这项研究将解决 关键证据差距，并为未来的研究提供了证据基础，以防止和减轻 HF的疲劳。它将为未来的症状科学研究计划奠定基础 HF疲劳症状科学的维度模型。这项研究与国家护理研究所保持一致 研究的战略计划重点是促进症状科学知识，以发展和 测试创新的干预措施，以减轻症状的痛苦并改善生活质量。