ACHIEVE P2 - HF

达到 P2 - HF

基本信息

批准号：
10662513
负责人：
David E Lanfear
金额：
$ 42.53万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
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/10662513
关键词：
Accounting Address Adult Affect Black Populations Black race Blood Pressure Brain natriuretic peptide COVID-19 testing Caring Clinical Clinical Trials Communities Community Health Aides Data Diabetes Mellitus Disease Early Intervention Echocardiography Effectiveness Employment Environment Event Glucose Transporter Great Lakes Region Guidelines Health Health Services Health Services Accessibility Heart Abnormalities Heart Diseases Heart Rate Heart failure Human Hypertension Incidence Individual Intervention Kidney Diseases Length Life Life Style Link Low income Maintenance Medical Methods Mobile Health Units Neighborhoods Outcome Participant Patients Persons Pharmaceutical Preparations Pharmacists Pharmacotherapy Phase Physical activity Population Practical Robust Implementation and Sustainability Model Prevention Protocols documentation Randomized Recommendation Recording of previous events Reduce health disparities Renal function Renin-Angiotensin System Research Resources Risk Risk Factors Sodium Target Populations Testing Vaccinated Vaccination black patient blood pressure control cardiometabolism care delivery clinical care collaborative care comorbidity contextual factors cost cost effectiveness effective therapy follow-up food insecurity health care availability health care settings health disparity health equity health inequalities heart function hypertensives implementation barriers improved inhibitor innovation kidney dysfunction mortality neighborhood disadvantage novel outreach personalized intervention prevent primary outcome programs randomized trial recruit screening social social health determinants social vulnerability standardize guidelines treatment optimization urban setting

Accounting Address Adult Affect Black Populations Black race Blood Pressure Brain natriuretic peptide COVID-19 testing Caring Clinical Clinical Trials Communities Community Health Aides Data Diabetes Mellitus Disease Early Intervention Echocardiography Effectiveness Employment Environment Event Glucose Transporter Great Lakes Region Guidelines Health Health Services Health Services Accessibility Heart Abnormalities Heart Diseases Heart Rate Heart failure Human Hypertension Incidence Individual Intervention Kidney Diseases Length Life Life Style Link Low income Maintenance Medical Methods Mobile Health Units Neighborhoods Outcome Participant Patients Persons Pharmaceutical Preparations Pharmacists Pharmacotherapy Phase Physical activity Population Practical Robust Implementation and Sustainability Model Prevention Protocols documentation Randomized Recommendation Recording of previous events Reduce health disparities Renal function Renin-Angiotensin System Research Resources Risk Risk Factors Sodium Target Populations Testing Vaccinated Vaccination black patient blood pressure control cardiometabolism care delivery clinical care collaborative care comorbidity contextual factors cost cost effectiveness effective therapy follow-up food insecurity health care availability health care settings health disparity health equity health inequalities heart function hypertensives implementation barriers improved inhibitor innovation kidney dysfunction mortality neighborhood disadvantage novel outreach personalized intervention prevent primary outcome programs randomized trial recruit screening social social health determinants social vulnerability standardize guidelines treatment optimization urban setting

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项目摘要

Abstract Heart failure (HF) is one of the most common, costly, and deadly diseases affecting humans. Hypertension is the largest single risk factor for HF, accounting for over half of all new cases. Moreover, Black adults with hypertension have a much greater risk, perhaps 20-fold, of developing HF compared with White adults. Accordingly, early interventions to prevent HF, in particular blood pressure (BP) control, are critical. However, implementation of effective treatments remains suboptimal among Black communities, especially in low- income urban settings. While many factors are involved, mounting evidence shows that adverse social determinants of heath (SDoH) such as poor access to healthcare, food insecurity, and lack of safe places for physical activity are critical barriers to the implementation of recommended therapies. To achieve health equity, improved strategies must be developed to overcome these negative SDoH. To better engage our at-risk community, our team developed an innovative mobile health unit (MHU) program that uses geospatial health and social vulnerability data to direct health services to communities in highest need, who may not otherwise engage with traditional health care settings. Another key to preventing HF is usage of guideline-directed medical therapy (GDMT), not only for treating high BP, but also providing medications proven to reduce HF incidence. In particular, inhibitors of sodium-glucose transporter type 2 (SGLT2) prevent HF and loss of kidney function in at-risk patients and recent data suggests enhanced benefit in Black patients. Yet, these are dramatically under-utilized in Blacks, further contributing to health disparities. In Project 2 of ACHIEVE GREATER (Addressing Cardiometabolic Health Inequities by Early Prevention in the Great Lakes Region) we will use a pragmatic, randomized, unblinded, clinical trial to implement and test a novel intervention leveraging our MHU platform to improve care access combined with enhanced collaborative care delivery among Black patients with Stage A HF (defined as asymptomatic individuals with known pre-conditions such as hypertension who are at-risk for later-stage clinical HF). The key components of our program are 1) a personalized intervention conducted by community health workers that addresses SDoH by linking patients with available community and social resources, and 2) pharmacist-directed therapy optimization per a standardized GDMT protocol. This intervention will address multiple domains and levels of impact to reduce the large gaps in care of stage-A HF patients in the Black community and prevent progression towards symptomatic HF.

抽象的心力衰竭（HF）是影响人类的最常见，昂贵和致命的疾病之一。高血压是 HF最大的单一风险因素，占所有新病例的一半以上。此外，黑人成年人与白人成年人相比，高血压具有发展HF的风险更大，可能是20倍。因此，预防HF的早期干预措施，特别是血压（BP）控制至关重要。然而，在黑人社区中，有效治疗的实施仍然是最佳的，尤其是在低 - 收入城市环境。尽管涉及许多因素，但越来越多的证据表明不利的社会荒地（SDOH）的决定因素，例如无法获得医疗保健，粮食不安全以及缺乏安全的地方体育活动是实施推荐疗法的关键障碍。实现健康必须制定公平，改进的策略来克服这些负面的SDOH。更好地吸引我们的高风险社区，我们的团队开发了一个创新的移动健康部门（MHU）计划，该计划使用地理空间健康和社会脆弱性数据以最高需求将卫生服务引向社区，他们可能不会参与传统的医疗保健环境。防止HF的另一个关键是指导指导医疗疗法（GDMT），不仅用于治疗高bp，而且还提供了被证明减少HF的药物发病率。特别是，2型钠 - 葡萄糖转运蛋白的抑制剂（SGLT2）预防HF和肾脏损失高危患者的功能和最近的数据表明，黑人患者的好处增强了。但是，这些是黑人的利用不足，进一步导致了健康差异。在成就的项目2中更大（通过大湖地区的早期预防来解决心脏代谢健康不平等）我们将使用务实的，随机的，未盲的临床试验来实施和测试利用新颖的干预措施我们改善护理访问的MHU平台以及黑色的增强协作护理交付患有A级HF的患者（定义为具有已知前条件的无症状个体，例如高血压的高血压，可用于晚期临床HF）。我们程序的关键组成部分是1）社区卫生工作者进行的个性化干预措施通过联系患者来解决SDOH 具有可用的社区和社会资源，以及2）药剂师指导的治疗优化标准化GDMT协议。这种干预将解决多个领域和影响水平，以减少照顾黑人社区中A阶段HF患者的巨大差距，并防止进展有症状的HF。