Effectiveness of Indoor Air Purifiers on Heart Failure Outcomes (The PURI-HF Trial)

项目摘要：室内空气净化器对心力衰竭结局的有效性(Puri-HF试验) 室内空气污染是导致全球死亡的主要风险因素之一，其中90%以上与污染有关 发生在低收入和中等收入国家的死亡。细模式颗粒物 空气动力学直径小于2.5微米(PM2.5)是全球发病率和 死亡率，特别是由于心血管疾病(CVD)。急性和非传染性疾病之间有很强的联系 慢性PM2.5空气污染暴露与心力衰竭(HF)发生率、住院和死亡率。多数 减少空气污染引起的心血管疾病的建议集中在改进烹饪技术上。 和通风，但结果好坏参半。改善空气质量和心血管健康的新战略是 需要的。在过去的几十年里，高效的颗粒物空气净化器被研究在 LMIC，以减少PM2.5污染，改善健康状况。然而，仍然存在很大差距。 了解空气净化器对功能和临床心衰结局的长期影响。我们是一家 成立了一组调查人员，在创新和有影响力的研究方面取得了成功的记录 空气污染和心血管疾病的交集。我们将利用我们的经验来研究创新的 减少空气污染的不利影响和改善印度的HF结果的方法。普瑞-HF 试验计划旨在证明手提式空气过滤器在改善空气质素方面的成效、可行性和成效 射血分数降低的心衰患者室内PM2.5水平与功能改善 在印度。我们计划在纽约大学格罗斯曼医学院和全印度研究所之间建立合作关系 医学部将始终强调能力建设和跨机构培训机会。 项目的持续时间。目标1将是一项随机对照试验，以评估阿司匹林的疗效 室内空气净化器对德里HReEF患者的HF功能容量(6分钟步行试验)的影响 Ludhiana和Thiruvananthapuram。我们还将进行适度分析，以评估是否达到 环境空气污染，以及空间/环境因素，缓和了空气净化器对 心衰结局。目标2将涉及因果调解分析，以确定PM2.5的减少是否 与空气净化器和HF结果之间的关系有关。我们还将评估是否 季节性与参与家庭室内PM2.5浓度的降低有关，以及 我们将在三项研究中确定空气净化器的使用对PM2.5空气污染成分的影响 网站。目标3将包括干预的成本效益分析和过程评价。 这项研究将由一个具有多样性和互补性的跨学科研究团队进行 由两名经验丰富的首席调查员领导的专业知识。我们打算在现有知识的基础上增加 创新和可扩展的战略，以改善全球环境和心血管健康。

Project Abstract: Effectiveness of Indoor Air Purifiers on Heart Failure Outcomes (PURI-HF Trial) Indoor air pollution is one of the leading risk factors for global mortality, with over 90% of pollution-related deaths occurring in low- and middle- income countries (LMICs). Fine mode particulate matter with an aerodynamic diameter smaller than 2.5 micrometers (PM2.5) is a major contributor to global morbidity and mortality, particularly due to cardiovascular disease (CVD). There is a strong link between both acute and chronic PM2.5 air pollution exposure and heart failure (HF) incidence, hospitalizations, and mortality. Most recommendations to reduce air pollution-mediated CVD have focused on improved cooking techniques and ventilation, but with mixed results. New strategies to improve air quality and cardiovascular health are needed. For the past few decades, high-efficiency particulate air (HEPA) purifiers have been studied in LMICs to decrease PM2.5 pollution and improve health outcomes. However, there remain substantial gaps in understanding the long-term effects of air purifiers on functional and clinical HF outcomes. We are an established group of investigators with a successful track record of innovative and impactful studies at the intersection of air pollution and CVD. We will leverage our experience to study the impact of an innovative approach to reduce the adverse impact of air pollution and improve HF outcomes in India. The PURI-HF Trial aims to demonstrate the efficacy, feasibility and effectiveness of portable air filters in improving indoor PM2.5 levels and improving functional capacity of HF patients with reduced ejection fraction (HFrEF) in India. Our proposed partnership between NYU Grossman School of Medicine and All India Institute of Medical Sciences will emphasize capacity building and cross-institutional training opportunities throughout the duration of the project. Aim 1 will be a randomized controlled trial to evaluate the effectiveness of indoor air purifiers on HF functional capacity (6-minute walk test) among patients with HReEF in Delhi, Ludhiana, and Thiruvananthapuram. We will also conduct a moderation analysis to evaluate whether level of ambient air pollution, as well as spatial/environmental factors, moderate the impact of air purifiers on HF outcomes. Aim 2 will involve a causal mediation analysis to determine if the reduction in PM2.5 is associated with the relationship between air purifiers and HF outcomes. We will also assess whether seasonality correlates with the reduction in indoor PM2.5 concentrations in participant households, and we will determine the impact of air purifier use on the composition of PM2.5 air pollution in the three study sites. Aim 3 will be comprised of a cost-effectiveness analysis and process evaluation of the intervention. The research will be conducted by a transdisciplinary research team with diverse and complementary expertise led by two experienced Principal Investigators. We intend to add to existing knowledge of innovative and scalable strategies to improve environmental and cardiovascular health worldwide.