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: 10658914
• 负责人: Chiadi E Ndumele
• 金额: $ 70.66万
• 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/10658914
• 关键词: Address; African American population; Ambulatory Care; Behavior Therapy; Clinical; Communities; Community Health; Community Health Aides; Complications of Diabetes Mellitus; Computerized Medical Record; Data; Diabetes Mellitus; Disparity; Education; Educational Intervention; Ethnic Origin; Evaluation; Feedback; Fibrosis; Functional disorder; Glycosylated hemoglobin A; Guidelines; Health system; Heart Injuries; Heart failure; Impairment; Individual; Intervention; Latino Population; Life Style; Link; 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; Race; Randomized, Controlled Trials; Resources; Risk; Risk Factors; Rural; Self Management; Socioeconomic Status; Support System; Target Populations; Testing; Training; Visit; Work; barrier to care; cardiometabolism; cardiorespiratory fitness; clinical risk; community based participatory research; cost; dietary; ethnic minority; ethnic minority population; evidence base; experience; fitness; functional status; geographic disparity; geographic risk; health care availability; health disparity; health equity; healthy lifestyle; improved; improved outcome; interest; intervention refinement; low socioeconomic status; member; mortality; neighborhood association; outcome disparities; patient engagement; pragmatic intervention; prevent; preventive intervention; primary outcome; prognostic; programs; racial minority; racial minority population; 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、死亡率和费用相关，人们对精炼心力衰竭（HF）怀有浓厚的兴趣。 降低心力衰竭风险的策略。糖尿病 (DM) 和低社会经济地位 (SES) 都是独立的风险 心力衰竭的因素，并且这两个因素一起与心力衰竭发生具有协同关联。一个主要功能 这些关联的后果是心肺健康受损，对预后和预后产生影响 生活质量。此外，低 SES 和 DM 在少数种族和族裔中所占比例过高， 因此是高频差异的一个原因。解决与以下组合相关的高心力衰竭风险的策略 低社会经济地位和低糖尿病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) 的支持可有效克服护理障碍、改善生活方式、糖尿病自我护理 管理、卫生系统参与和风险因素控制，但尚未应用于 解决心衰风险。通过了解心力衰竭的地理差异，可以进一步了解预防工作 风险并阐明可作为干预目标的临床风险因素。因此我们建议 在 350 名低 SES、糖尿病、肥胖和早期心功能障碍患者中进行的随机试验，测试了 问题解决培训、社区卫生工作者支持以及与社区合作等多层次干预的效果 支持生活方式改变的设施，包括健康、危险因素控制、心脏损伤/纤维化标志物和质量 的生活。我们建议： 目标 1：使用电子病历数据 a) 比较以下各项之间的关联： 城市、农村和郊区的 DM 患者发生心力衰竭的社区 SES， b) 确定与糖尿病相关的心力衰竭的可改变的临床危险因素，这些危险因素在以下人群中更为普遍： 社会经济地位低的人。目标 2：采用基于证据的务实干预措施来改善 低 SES、糖尿病、肥胖和早期心脏病患者的功能状态和危险因素控制 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）原则。目标 3：在随机对照试验中测试 1 年多水平是否有效 干预问题解决培训、社区卫生工作者的使用以加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的改变，改善心肺功能 低 SES、糖尿病、肥胖和早期心功能障碍患者的健康和相关结果，更多 而不是加强教育以及与社区卫生计划的联系。这项工作将阐明 解决与低 SES 和 DM 相关的 HF 风险的策略，这是造成 HF 差异的关键因素。