Improving diagnosis of heart failure with preserved ejection fraction in primary care.

在初级保健中通过保留射血分数改善心力衰竭的诊断。

• 批准号: 10738561
• 负责人: Yulia Khodneva
• 金额: $ 19.23万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-25 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738561
• 关键词: Active Learning; Acute; Affect; Alabama; American; American Heart Association; Award; Cardiology; Caring; Clinic; Clinical; Clinical Data; Clinical Medicine; Collaborations; Communication; Communities; Community Physician; Community Practice; Complement; Complex; Computerized Medical Record; Data; Development; Diagnosis; Diagnostic; Doctor of Philosophy; EFRAC; Early Diagnosis; Echocardiography; Education; Elderly; Enrollment; Epidemiology; European; Focus Groups; Functional disorder; Funding; Future; General Practices; Glucose; Goals; Grant; Guidelines; Health; Health Services Research; Heart Rate; Heart failure; Hospitalization; Internist; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning Module; Light; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Newly Diagnosed; Outcome; Parents; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Pragmatic clinical trial; Prevalence; Primary Care; Process; Program Development; Prospective Studies; Publishing; Pulmonary Hypertension; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Priority; Resources; Review Literature; Risk; Risk Factors; Role; Series; Societies; Sodium; Structure; Surveys; Testing; Time; Training; Update; acceptability and feasibility; arm; care outcomes; career development; clinical diagnostics; college; comorbidity; cost; demographics; design; diagnostic criteria; diagnostic strategy; efficacy testing; experience; feasibility testing; future implementation; health care delivery; implementation science; improved; improved outcome; inhibitor; innovation; intervention mapping; mortality; novel; pilot test; point of care; poor health outcome; practice-based research network; preference; preservation; primary care provider; primary outcome; provider factors; provider-level barriers; recruit; research study; skill acquisition; skills; symporter; therapy development; treatment guidelines; urban area

ABSTRACT Heart failure affects 6 million people in the US, resulting on 1 million hospitalizations and a cost of over $30 billion per year. Heart failure with preserved election fraction (HFpEF) accounts for half of these cases, and its prevalence is rising by 1% annually. About 20-30% of HFpEF cases remain undiagnosed, contributing to poor health outcomes for these patients. Preliminary data suggest that primary care providers (PCPs) are often unaware of diagnostic and treatment guidelines for HFpEF. At the same time, primary care has an invaluable potential to improve HFpEF health outcomes by facilitating early diagnosis, referral to cardiology, and treating HFpEF comorbidities. The objective of this proposal is to design and test a novel intervention that will educate PCPs about HFpEF and provide them with a clinical diagnostic decision support aide (CDDSA) that is based on a validated diagnostic score for HFpEF. The overall hypothesis of this project is that if PCPs can detect HFpEF earlier, and therefore, refer patients to cardiology, and manage their comorbidities, it can help improve outcomes in HFpEF. Building on established community-academic collaborations, this project will be conducted with the help of the Alabama Practice-Based Research Network (APBRN). This project will include identification of provider barriers to HFpEF diagnosis among PCPs via an interview and a survey that will measure the prevalence of HFpEF knowledge gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational session and CDDSA to optimize HFpEF diagnosis in primary care (Aim 2); and a pilot study to test the feasibility and acceptability of the CDDSA (Aim 3). At the completion of the pilot study in Aim 3, the intervention will be ready to be tested at a larger scale (e.g., R-series grant) to evaluate its efficacy. The candidate for this career development award, Yulia Khodneva, MD, PhD, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills necessary for her transition to independence focusing her research on improving healthcare delivery, and outcomes for HFpEF patients. Specifically, Dr. Khodneva will receive training in intervention development, implementation science, and conducting of pragmatic clinical trials, designed to improve healthcare delivery and outcomes for HFpEF patients. Dr. Khodneva will be mentored by two NHLBI-funded physician- investigators, Andrea Cherrington, MD (primary mentor; expert in intervention development and pragmatic clinical trials), Pankaj Arora, MD, (co-mentor; expert in HFpEF diagnosis and HFpEF echocardiography), and Larry Hearld, PhD (co-mentor; expert in implementation science). The combination of mentorship, formal coursework, and the proposed experiential learning during the project’s 5-year integrated training and research plan will position Dr. Khodneva to become an independent investigator while advancing the field of primary care for HFpEF patients.

抽象的 心力衰竭影响美国 600 万人，导致 100 万人住院治疗，费用超过 30 美元 每年 10 亿美元，其中半数为保留选择分数的心力衰竭 (HFpEF)。 患病率每年上升 1%，约 20-30% 的 HFpEF 病例仍未确诊，导致贫困。 初步数据表明，初级保健提供者 (PCP) 往往会影响这些患者的健康结果。 不了解 HFpEF 的诊断和治疗指南 同时，初级保健具有无价的价值。 通过促进早期诊断、转诊心脏病学和治疗来改善 HFpEF 健康结果的潜力 该提案的目的是设计和测试一种新颖的干预措施，以进行教育。 PCP 了解 HFpEF 并向他们提供临床诊断决策支持援助 (CDDSA)，该援助基于 经验证的 HFpEF 诊断评分 该项目的总体假设是 PCP 是否能够检测到 HFpEF。 因此，尽早将患者转诊至心脏病科并管理其合并症，有助于改善结果 在 HFpEF 中，该项目将在已建立的社区学术合作的基础上进行。 阿拉巴马州基于实践的研究网络 (APBRN) 的帮助该项目将包括识别 通过访谈障碍和一项衡量 PCP HFpEF 诊断的调查提供者 HFpEF 知识差距和干预偏好的普遍性（目标 1）； 设计教育课程和 CDDSA 的流程，以优化初级保健中的 HFpEF 诊断（目标 2）； 一项试点研究，以测试 CDDSA 的可行性和可接受性（目标 3）。 目标 3，干预措施将准备好进行更大规模的测试（例如 R 系列拨款）以评估其功效。 该职业发展奖的候选人尤利娅·霍德涅娃（Yulia Khodneva）医学博士、哲学博士是一位拥有专业知识的普通内科医生 该奖项将使她获得临床医学、流行病学和卫生服务研究方面的技能。 她过渡到独立是必要的，她的研究重点是改善医疗保健服务，以及 具体来说，Khodneva 博士将接受干预开发方面的培训， 实施科学并进行务实的临床试验，旨在改善医疗保健服务和 Khodneva 博士将由两名 NHLBI 资助的医师研究员进行指导， Andrea Cherrington，医学博士（主要导师；干预开发和实用临床试验专家）， Pankaj Arora，医学博士（共同导师；HFpEF 诊断和 HFpEF 超声心动图专家）和 Larry Hearld， 博士（共同导师；实施科学专家）。 在该项目的 5 年综合培训和研究计划期间提出的体验式学习将使博士能够定位。 Khodneva 将成为一名独立研究者，同时推进 HFpEF 患者的初级保健领域。