Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF)

心力衰竭的身体虚弱和症状监测和管理行为 (PRISM-HF)

• 批准号: 10740609
• 负责人: Quin Eleanor Denfeld
• 金额: $ 41.77万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740609
• 关键词: Accounting; Address; Adult; Adverse effects; Adverse event; Affect; Age; Behavior; Behavioral; Biological; Body Weight decreased; Cardiovascular system; Clinical; Complement; Data; Decision Making; Development; Dyspnea; Event; Exertion; Future; Goals; Health Promotion; Heart failure; Hospitalization; Intervention; Interview; Knowledge; Logistic Models; Maintenance; Methods; Modeling; Monitor; Outcome; Patient-Focused Outcomes; Patients; Phase; Phenotype; Physical activity; Physical assessment; Physiological; Precision Health; Provider; Public Health; Quality of life; Reporting; Research; Risk; Sampling; Self Care; Sex Differences; Structure; Sum; Symptoms; System; Time; Woman; Work; adverse outcome; biobehavior; comorbidity; design; exhaustion; experience; frailty; health disparity; health equity; improved; innovation; insight; lens; men; outcome disparities; prevent; sex; symptom management; theories

PROJECT SUMMARY While heart failure (HF) is the fastest growing cardiovascular condition in the U.S., about half of adults with HF are also considered physically frail. In recent years, there is a better understanding of the intersection of physical frailty with HF, including the strong association between physical frailty and worse patient-reported and clinical outcomes in HF. Additionally, evidence shows that physical frailty affects women more than men in HF. However, there is a lack of understanding of how physical frailty is associated with adverse outcomes, which hinders our ability to develop and deploy effective biobehavioral interventions to mitigate these adverse outcomes. While there has been work characterizing the biological profile of physical frailty in HF, the behavioral profile has not been characterized from either a quantitative or qualitative perspective. One key behavior that adults with HF must engage in is symptom monitoring and management (SMM). Monitoring for HF symptoms and engaging in decision-making to address these symptoms (e.g. recognizing dyspnea on exertion and calling a provider) are important behaviors that reduce adverse patient-reported and clinical outcomes. Physical frailty, however, may impact SMM behaviors by blunting the monitoring of symptoms and hindering the management of symptoms, resulting in adverse outcomes. Understanding the relationship of physical frailty with SMM behaviors may characterize the behavioral profile of physically frail adults with HF, offer one possible explanation by which physical frailty affects outcomes in HF, and provide a means of developing and deploying effective biobehavioral interventions to address physical frailty in HF, our long-term goal. Therefore, the objectives of this exploratory study are to 1) characterize the relationship between physical frailty, SMM behaviors, and outcomes, and 2) identify SMM behaviors, aligned with the patient's perspective, to target with biobehavioral interventions. The proposed study utilizes a sequential mixed methods approach wherein in Phase 1, we will collect cross-sectional quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we will collect qualitative data from ~32-40 adults with the following aims: 1) quantify associations among physical frailty, SMM behaviors, and outcomes in adults with HF; 2) describe the experience of SMM behaviors for physically frail and non- physically frail adults with HF; and 3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. Accomplishing this state-of-the-art study is an important stepping stone towards the development of larger proposals. Specifically, it will allow our team to merge our understanding of physical frailty from a biological perspective with that of a behavioral perspective to develop biobehavioral interventions to mitigate the adverse patient-reported and clinical outcomes associated with physical frailty in HF.

项目概要 虽然心力衰竭 (HF) 是美国增长最快的心血管疾病，但大约一半患有心力衰竭的成年人 也被认为身体虚弱。近年来，人们对物理与物理交叉点有了更深入的了解。 心衰导致的虚弱，包括身体虚弱与患者报告和临床情况恶化之间的密切关联 心力衰竭的结果。此外，有证据表明，身体虚弱对心衰患者的影响比男性更大。然而， 人们对身体虚弱与不良后果之间的关系缺乏了解，这阻碍了我们 开发和部署有效的生物行为干预措施以减轻这些不良后果的能力。尽管 已经有工作描述了心衰患者身体虚弱的生物学特征，但行为特征还没有 从定量或定性的角度来表征。心力衰竭成人患者的一项关键行为 必须从事的是症状监测和管理（SMM）。监测心力衰竭症状并参与 解决这些症状的决策（例如识别劳累时呼吸困难并致电医疗服务提供者） 减少不良患者报告和临床结果的重要行为。然而身体虚弱可能 通过削弱症状监测和阻碍症状管理来影响 SMM 行为， 导致不良后果。了解身体虚弱与 SMM 行为的关系可能会 描述患有心衰的身体虚弱成年人的行为特征，提供一种可能的解释 身体虚弱会影响心力衰竭的结果，并提供一种开发和部署有效生物行为的方法 采取干预措施来解决心衰患者的身体虚弱问题，这是我们的长期目标。因此，本次探索性研究的目标 研究目的是 1) 描述身体虚弱、SMM 行为和结果之间的关系，以及 2) 识别 SMM 行为，与患者的观点保持一致，以进行生物行为干预。这 拟议的研究采用顺序混合方法，其中在第一阶段，我们将收集横截面数据 来自 120 名 HF 成年人的性别平衡样本的定量数据，在第 2 阶段，我们将收集定性数据 来自约 32-40 名成年人的数据，目的如下：1）量化身体虚弱、SMM 行为之间的关联， 成人心力衰竭患者的情况和结局； 2) 描述身体虚弱和非健康人士的 SMM 行为体验 患有心力衰竭、身体虚弱的成年人； 3) 识别身体虚弱和非身体状况的 SMM 行为需求 患有心衰的体弱成人。完成这项最先进的研究是迈向 制定更大的提案。具体来说，它将让我们的团队融合我们对身体虚弱的理解 从生物学角度和行为角度出发，制定生物行为干预措施 减轻与心力衰竭身体虚弱相关的不良患者报告和临床结果。