ACHIEVE P2 - HF

达到 P2 - HF

• 批准号: 10437397
• 负责人: David E Lanfear
• 金额: $ 35.55万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437397
• 关键词: Accounting; Address; Adult; Affect; Blood Pressure; Brain natriuretic peptide; COVID-19 testing; Caring; Clinical; Clinical Trials; Communities; Community Health Aides; Data; Diabetes Mellitus; Disadvantaged; Disease; Early Intervention; Echocardiography; Effectiveness; Employment; Environment; Event; Glucose Transporter; Great Lakes Region; Guidelines; Health; Health Services; Health Services Accessibility; Heart Abnormalities; Heart Diseases; Heart Rate; Heart failure; Human; Hypertension; Incidence; Individual; Intervention; Kidney Diseases; Length; Life; Life Style; Link; Low income; Maintenance; Medical; Methods; Mobile Health Units; Neighborhoods; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacotherapy; Phase; Physical activity; Population; Practical, Robust Implementation and Sustainability Model; Prevention; Protocols documentation; Randomized; Recommendation; Recording of previous events; Renal function; Renin-Angiotensin System; Research; Resources; Risk; Risk Factors; Sodium; Target Populations; Testing; Vaccinated; Vaccination; base; black patient; blood pressure regulation; cardiometabolism; care delivery; clinical care; collaborative care; comorbidity; contextual factors; cost; cost effectiveness; effective therapy; follow-up; food insecurity; health care availability; health care settings; health disparity; health equity; health inequalities; heart function; improved; inhibitor/antagonist; innovation; kidney dysfunction; mortality; novel; outreach; personalized intervention; prevent; primary outcome; programs; randomized trial; recruit; screening; social; social determinants; social vulnerability; standardize guidelines; treatment optimization; urban setting

Abstract Heart failure (HF) is one of the most common, costly, and deadly diseases affecting humans. Hypertension is the largest single risk factor for HF, accounting for over half of all new cases. Moreover, Black adults with hypertension have a much greater risk, perhaps 20-fold, of developing HF compared with White adults. Accordingly, early interventions to prevent HF, in particular blood pressure (BP) control, are critical. However, implementation of effective treatments remains suboptimal among Black communities, especially in low- income urban settings. While many factors are involved, mounting evidence shows that adverse social determinants of heath (SDoH) such as poor access to healthcare, food insecurity, and lack of safe places for physical activity are critical barriers to the implementation of recommended therapies. To achieve health equity, improved strategies must be developed to overcome these negative SDoH. To better engage our at-risk community, our team developed an innovative mobile health unit (MHU) program that uses geospatial health and social vulnerability data to direct health services to communities in highest need, who may not otherwise engage with traditional health care settings. Another key to preventing HF is usage of guideline-directed medical therapy (GDMT), not only for treating high BP, but also providing medications proven to reduce HF incidence. In particular, inhibitors of sodium-glucose transporter type 2 (SGLT2) prevent HF and loss of kidney function in at-risk patients and recent data suggests enhanced benefit in Black patients. Yet, these are dramatically under-utilized in Blacks, further contributing to health disparities. In Project 2 of ACHIEVE GREATER (Addressing Cardiometabolic Health Inequities by Early Prevention in the Great Lakes Region) we will use a pragmatic, randomized, unblinded, clinical trial to implement and test a novel intervention leveraging our MHU platform to improve care access combined with enhanced collaborative care delivery among Black patients with Stage A HF (defined as asymptomatic individuals with known pre-conditions such as hypertension who are at-risk for later-stage clinical HF). The key components of our program are 1) a personalized intervention conducted by community health workers that addresses SDoH by linking patients with available community and social resources, and 2) pharmacist-directed therapy optimization per a standardized GDMT protocol. This intervention will address multiple domains and levels of impact to reduce the large gaps in care of stage-A HF patients in the Black community and prevent progression towards symptomatic HF.

摘要 心力衰竭（HF）是影响人类的最常见、最昂贵和最致命的疾病之一。高血压是 是心力衰竭最大的单一风险因素，占所有新病例的一半以上。此外，黑人成年人 与白色成年人相比，高血压患者发生HF风险更大，可能是20倍。 因此，预防HF的早期干预，特别是血压（BP）控制至关重要。然而，在这方面， 有效治疗的实施在黑人社区中仍然不是最理想的，特别是在低收入社区， 收入城市环境。虽然涉及到许多因素，但越来越多的证据表明，不利的社会因素 健康决定因素（SDoH），例如获得医疗保健的机会少、粮食不安全以及缺乏安全的场所 体力活动是实施推荐疗法的关键障碍。实现健康 为了公平起见，必须制定改进的战略来克服这些负面的SDoH。为了更好地让我们的风险 社区，我们的团队开发了一个创新的移动的医疗单位（MHU）计划，使用地理空间健康 和社会脆弱性数据，将卫生服务导向最需要的社区， 与传统的医疗机构合作。预防HF的另一个关键是使用指南指导的 药物治疗（GDMT），不仅用于治疗高血压，还提供经证明可减少HF的药物 发病率。特别是，钠-葡萄糖转运蛋白2（SGLT 2）抑制剂可预防HF和肾功能丧失 在高危患者中的功能，最近的数据表明黑人患者的获益增强。然而， 在黑人中使用严重不足，进一步加剧了健康差距。在ACHIEVE项目2中， GREATER（五大湖地区通过早期预防解决心脏代谢健康不平等问题）， 我将使用一个务实的，随机的，非盲的，临床试验来实施和测试一种新的干预措施， 我们的MHU平台，以改善护理服务，并加强黑人之间的合作护理服务 A期HF患者（定义为具有已知前提条件的无症状个体，例如 处于晚期临床HF风险高血压患者）。我们计划的主要组成部分是1）a 由社区卫生工作者进行的个性化干预，通过将患者联系起来解决SDoH问题 利用可用的社区和社会资源，以及2）药剂师指导的治疗优化 标准化GDMT协议。这一干预措施将涉及多个领域和多个层面的影响， 黑人社区A期HF患者的护理存在巨大差距， 症状性HF。