Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure

分析晚期心力衰竭对机械支持的生物行为反应

基本信息

批准号：
8271833
负责人：
Christopher Sean Lee
金额：
$ 34.65万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8271833
关键词：
Acceleration Activities of Daily Living Acute Address Adult Anxiety Behavioral Research Biological Markers Breeding Cardiovascular Diseases Clinical Clinical Management Clinical Research Complex Data Decision Making Destinations Devices Education Elderly Eligibility Determination Event Exertion Family Functional disorder Future Goals Growth Health Heart Transplantation Heart failure Heterogeneity Hospitalization Hostility Inflammation Intervention Life Link Mechanics Medical Modeling Monitor Myocardial Organ Donations Outcome Pain Pathogenesis Patients Persons Population Process Provider Quality of life Refractory Research Rest Risk Serum Shapes Stress Symptoms Technology Testing Time United States biobehavior biological research clinically relevant cohort depressive symptoms follow-up health related quality of life implantation improved insight patient oriented psychologic response symptom management time use treatment strategy ventricular assist device

项目摘要

DESCRIPTION (provided by applicant): Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and the most common reason for hospitalization among older adults. Many patients with HF have symptoms at rest or with minimal exertion that become refractory to optimal medical therapy. Fewer than 5% of these advanced HF patients are eligible for heart transplantation, and organ donations are extremely limited. As such, mechanical circulatory support with a ventricular assist device (VAD) has emerged as a primary treatment for advanced HF. There is significant and unexplained heterogeneity in clinical outcomes and quality-of-life after VAD implantation. Moreover, we know very little about how physical and psychological symptoms may relate to changes in underlying HF pathogenesis and how symptoms and pathogenic biomarkers may explain differential responses to VAD implantation. Accordingly, our research goals are to a) characterize common and distinct trajectories of change in symptoms and pathogenic biomarkers during the transition from advanced HF through the first 6 months after VAD implantation, and b) link changes in symptoms and biomarkers over time to clinical events and quality-of-life. We will collect data from a cohort of 120 adults with advanced HF prior to, and for a period of 6 months after VAD implantation. Our aims are to: 1) identify common trajectories of change in physical and psychological symptoms, 2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction, and 3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Importantly, we will codify the clinical relevance of different symptom and biomarker trajectories in terms of clinical-event risk and health-related quality-of-life. This interdisciplinary clinical research integrates and advances prior biological and behavioral research and is centered on an advanced technological treatment of a high profile cardiovascular disorder. These research findings will be used to enhance shared patient and provider decision-making regarding VAD implantation, and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation. PUBLIC HEALTH RELEVANCE: This study involves a primary treatment for advanced heart failure, the fastest growing cardiovascular disorder in the United States. The results of this stud will be used to enhance patient and provider decision-making about advanced therapies for heart failure, and to develop personalized interventions to improve patient- oriented and clinical outcomes.

描述（由申请人提供）：心力衰竭 (HF) 是美国增长最快的心血管疾病，也是老年人住院的最常见原因。许多心力衰竭患者在休息或轻微活动时都会出现症状，这些症状对最佳药物治疗无效。这些晚期心力衰竭患者中只有不到5%有资格接受心脏移植，器官捐献也极其有限。因此，心室辅助装置 (VAD) 的机械循环支持已成为晚期心力衰竭的主要治疗方法。 VAD 植入后的临床结果和生活质量存在显着且无法解释的异质性。此外，我们对身体和心理症状如何与潜在心力衰竭发病机制的变化相关以及症状和致病生物标志物如何解释对 VAD 植入的差异反应知之甚少。因此，我们的研究目标是 a) 描述从晚期 HF 过渡到 VAD 植入后前 6 个月期间症状和致病生物标志物变化的常见和独特轨迹，以及 b) 将症状和生物标志物随时间的变化与临床事件联系起来和生活质量。我们将从 120 名患有晚期心力衰竭的成年人中收集 VAD 植入前和植入后 6 个月的数据。我们的目标是：1) 确定身体和心理症状变化的常见轨迹，2) 描述心肌应激、全身炎症和内皮功能障碍的血清生物标志物变化的常见轨迹，以及 3) 量化症状和发病机制生物标志物之间的关联接受 VAD 植入的成人。重要的是，我们将在临床事件风险和健康相关生活质量方面整理不同症状和生物标志物轨迹的临床相关性。这项跨学科的临床研究整合并推进了先前的生物学和行为研究，并以先进的技术治疗备受瞩目的心血管疾病为中心。这些研究结果将用于加强患者和医疗服务提供者关于 VAD 植入的共同决策，并制定急需的新型干预措施和临床管理策略，以适应 VAD 植入的不同症状和致病反应。公众健康相关性：这项研究涉及晚期心力衰竭的主要治疗，这是美国增长最快的心血管疾病。该研究的结果将用于增强患者和提供者关于心力衰竭先进疗法的决策，并开发个性化干预措施以改善以患者为导向的临床结果。