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.

项目概要 据估计，美国有 620 万成年人患有心力衰竭 (HF)。1 重要的是，这种使人衰弱的疾病 该综合征会导致严重的发病率和死亡率，每年报告有近 80,000 例与心力衰竭相关的死亡。1 疲劳是心力衰竭患者的一种普遍且令人痛苦的症状，有证据表明疲劳与 显着的预后和结果影响。2,3,4 心衰患者疲劳的存在及其严重程度增加 增加住院5,6和死亡率7,8的风险，并与抑郁症增加相关3,4,9,10, 生活质量较差11,12，自我保健能力较差13，身体14,15,3，社交14和情感功能下降。 16 文献中将心衰时的疲劳分为两种类型：1) 一般性疲劳和 2) 劳力性疲劳。 1) 一般性疲劳和 2) 劳力性疲劳。一般性疲劳和劳力性疲劳及其同时发生的情况是 理解这一点很重要，因为它们的预测因素和相关结果可能有所不同。准确的 疲劳类型的识别可能会导致采取不同的干预措施来缓解疲劳。然而，很少 证据检查了患者报告的一般性疲劳和劳力性疲劳之间的临床结果差异， 尚未确定临床相关的疲劳预测因子，并且疲劳体验存在差异 HFrEF 和 HFpEF 之间的关系尚未被探索。这限制了我们对风险的理解 心力衰竭疲劳类型的影响因素和相关结果。本研究旨在利用二次数据分析 表征疲劳类型，量化疲劳类型与临床和患者之间的关系 报告结果，并检查疲劳类型的心脏结构和功能预测因素 社区动脉粥样硬化风险 (ARIC) 研究中患有 HFrEF 和 HFpEF 的患者。这将是 通过以下具体目标来实现： 目标 1：定义患有以下疾病的个体的不同类型的疲劳 慢性心力衰竭。目标 2：量化疲劳类型与心力衰竭再入院之间的纵向关联 和死亡率，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测量之间的横截面关系（左心室 (LV) 结构、左心室收缩功能、左心室舒张功能）、心力衰竭表型（HFrEF 与 HFpEF）和疲劳类型 （根据年龄、性别、社会经济状况、BMI、合并症和药物进行调整）。这项研究将解决 关键的证据差距，并为未来的研究提供证据基础，以预防和减轻影响 高频疲劳。它将为未来的症状科学研究计划奠定基础，调查多方面的症状。 高频疲劳症状科学的维度模型。这项研究与国家护理研究所一致 研究的战略计划重点是推进症状科学知识的发展和目标 测试创新干预措施以减轻症状并提高生活质量。