Targeting cognitive function and interoceptive awareness to improve self-management in patients with co-morbid heart failure and cognitive impairment.

项目概要/摘要 由于人口老龄化，心力衰竭（HF）正在达到流行病的比例，现在是最常见的 美国老年人的出院诊断。HF具有不利的预后， 6个月再入院率和5年死亡率均达到50%。提高临床 结果，患者实施充分的自我护理至关重要，即，他们坚持药理学和 生活方式的建议，并监测他们的症状，以确保他们得到及时的医疗照顾 时尚.轻度认知功能障碍（MCI）影响多达三分之二的HF患者，并且是其治疗的关键障碍。 能够有效地进行自我护理。尽管它对自我护理和临床结果有负面影响， 少数自我护理干预研究专门针对MCI和针对此的干预措施。 迫切需要重要的合作伙伴。有初步证据表明，正念训练（MT）可以 改善MCI患者认知功能。MT也被证明可以改善内感受性 意识，一种可以提高患者及时识别HF症状恶化的能力的技能 时尚，更快地接受治疗，并可能防止再次入院。最后，通过放松 MT增强迷走神经控制，这与更好的认知功能有关。这 为响应PAR-20 - 180 "确定创新机制或干预措施， 目标多模态及其后果"，并符合NIA的利益，将利用我们的专业知识， 慢性病患者的远程MT，以进行II期机制RCT，包括以下内容 目的：a）研究MT对慢性阻塞性肺疾病患者认知功能和内感受性意识的影响， 病态MCI和HF，B）评估这些近端因素的改善是否会对自我产生积极影响 c）研究MT在此过程中改善认知的潜在生理机制。 人口患有HF和MCI的稳定门诊患者（n = 176）将被随机分配到电话交付MT（a 每周30分钟的课程，持续8周，结合20分钟的每日个人指导练习， 记录）加增强型常规护理（EUC）或单独给予EUC。与目前的建议一致，通常 将通过自我护理教育材料加强这两个群体的护理。基线时，3个月（结束时） 治疗），基线后9个月，参与者将接受全面的认知评估， 功能、内感受性意识、HF自我护理和其他心理行为因素、心脏迷走神经控制，以及 HF生物标志物。这是第一次严格调查MT对认知功能，内感受性， 意识和自我护理的患者共病MCI和HF。证明了通过提高认知能力 MT可促进HF和MCI共病患者的自我护理， 为MT融入康复计划和自我护理干预铺平道路，以改善临床 这一弱势群体的结果。

PROJECT SUMMARY/ABSTRACT Due to population ageing, heart failure (HF) is reaching pandemic proportions and is now the most common hospital discharge diagnosis among older adults in the United States. HF carries an unfavorable prognosis, with both 6-month hospital readmissions and 5-year mortality rates reaching 50%. To improve clinical outcomes, it is critical that patients implement adequate self-care, i.e., they adhere to pharmacological and lifestyle recommendations and monitor their symptoms to ensure they receive medical attention in a timely fashion. Mild cognitive impairment (MCI) affects up to two-thirds of patients with HF and is a key barrier to their ability to effectively implement self-care. Despite its negative impact on self-care and on clinical outcomes, only a small number of self-care intervention studies specifically address MCI and interventions targeting this important comorbidity are sorely needed. There is preliminary evidence that mindfulness training (MT) can improve cognitive function in individuals with MCI. MT has also been shown to improve interoceptive awareness, a skill which could increase the patient’s ability to recognize worsening of HF symptoms in a timely fashion, receive treatment sooner, and potentially prevent re-admissions. Finally, by eliciting the relaxation response, MT enhances vagal control, which has been associated with better cognitive function. This application, designed in response to PAR-20-180 “Identifying innovative mechanisms or interventions that target multimorbidity and its consequences” and in line with NIA interests, will leverage our expertise with remote MT for patients with chronic conditions to conduct a phase II mechanistic RCT with the following objectives: a) To study the effects of MT on cognitive function and interoceptive awareness in patients with co- morbid MCI and HF, b) To assess whether improvements in these proximal factors could positively impact self- care and c) To study the underlying physiological mechanisms by which MT could improve cognition in this population. Stable outpatients (n=176) with HF and MCI will be randomly assigned to phone-delivered MT (a weekly, 30-minute session for 8 weeks integrated with a 20-min guided daily individual practice via digital recordings) plus enhanced usual care (EUC) or to EUC alone. Consistent with current recommendations, usual care will be enhanced in both groups with self-care education materials. At baseline, 3 months (end of treatment), and 9 months since baseline participants will undergo comprehensive assessments of cognitive function, interoceptive awareness, HF self-care and other psycho-behavioral factors, cardiac vagal control, and HF biomarkers. This is the first rigorous investigation of the effects of MT on cognitive function, interoceptive awareness, and self-care in patients with co-morbid MCI and HF. Demonstrating that, by improving cognitive performance and interoceptive awareness, MT promotes self-care in patients with co-morbid HF and MCI will pave the way to the integration of MT into rehabilitation programs and self-care interventions to improve clinical outcomes in this vulnerable population.