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

项目摘要/摘要 由于人口老龄化，心力衰竭(HF)正达到大流行的程度，现在是最常见的 美国老年人的出院诊断。心衰预后不佳， 再住院6个月和5年死亡率均达到50%。做好临床工作 对于结果，至关重要的是患者实施适当的自我护理，即他们坚持药物和 建议他们的生活方式并监测他们的症状，以确保他们得到及时的医疗救治 时尚。轻度认知障碍(MCI)影响多达三分之二的心力衰竭患者，是影响他们 有效实施自我护理的能力。尽管它对自我护理和临床结果有负面影响，但只有 少数自我护理干预研究专门针对MCI和针对这一目标的干预 重要的共病是迫切需要的。有初步证据表明正念训练(MT)可以 改善MCI患者的认知功能。MT也被证明可以改善内感。 意识，一种可以提高患者及时识别心力衰竭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，通过引出放松 反应，MT增强迷走控制，这与更好的认知功能有关。这 应用程序，根据PAR-20-180“确定创新机制或干预措施 目标多发病及其后果“，并符合NIA的利益，将利用我们的专业知识 用于慢性病患者的远程MT，用于使用以下设备进行II期机械性RCT 目的：1)研究MT对慢性阻塞性肺疾病患者认知功能和内感意识的影响。 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 CARE和c)研究MT改善认知功能的潜在生理机制 人口。患有心力衰竭和MCI的176名稳定的门诊患者将被随机分配到电话递送的MT(A)组 每周30分钟的课程，为期8周，并通过数字技术每天指导20分钟的个人练习 录音)加上增强型日常护理(EUC)或仅向EUC发送。与当前建议一致，通常如此 两组都将通过使用自我护理教育材料来加强护理。按基准计算，3个月(年末 治疗)，从基线开始9个月后，参与者将接受全面的认知评估 功能，内感意识，心衰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。这是第一次关于MT对认知功能、内感的影响的严格研究 MCI合并心力衰竭患者的意识和自我护理。这表明，通过改善认知 表现和内感意识，MT促进心力衰竭和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 在这一弱势群体中的结果。

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.