ACHIEVE P2 - HF

摘要 心力衰竭 (HF) 是影响人类的最常见、最昂贵且致命的疾病之一。高血压是 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 与白人成年人相比，高血压患者患心力衰竭的风险要高得多，可能是白人成年人的 20 倍。 因此，预防心力衰竭的早期干预措施，特别是控制血压（BP）至关重要。然而， 在黑人社区中，有效治疗的实施仍然不够理想，特别是在低收入社区 收入城市环境。虽然涉及许多因素，但越来越多的证据表明，不利的社会 健康决定因素 (SDoH)，例如医疗保健获取机会差、粮食不安全以及缺乏安全场所 体力活动是实施推荐疗法的关键障碍。达到健康 公平，必须制定改进的策略来克服这些负面的 SDoH。为了更好地吸引我们的高风险人群 社区中，我们的团队开发了一个创新的移动健康单元 (MHU) 程序，该程序使用地理空间健康 和社会脆弱性数据，以便为最需要的社区提供卫生服务，否则这些社区可能不会 参与传统的医疗保健环境。预防心力衰竭的另一个关键是使用指南指导的方法 药物治疗 (GDMT)，不仅用于治疗高血压，还提供经证明可减少心力衰竭的药物 发生率。特别是，2 型钠-葡萄糖转运蛋白 (SGLT2) 抑制剂可预防心力衰竭和肾功能丧失 高危患者的功能，最近的数据表明黑人患者的获益增强。然而，这些都是 黑人的利用严重不足，进一步加剧了健康差距。在ACHIEVE项目2中 GREATER（通过早期预防解决五大湖地区心脏代谢健康不平等问题）我们 将使用务实的、随机的、非盲的临床试验来实施和测试一种新颖的干预措施 我们的 MHU 平台旨在改善护理服务的可及性，并加强黑人之间的协作护理服务 A 期心力衰竭患者（定义为具有已知先决条件的无症状个体，例如 有晚期临床心力衰竭风险的高血压患者）。我们计划的关键组成部分是 1) 由社区卫生工作者进行的个性化干预，通过联系患者来解决 SDoH 具有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。这种干预措施将解决多个领域和影响程度，以减少 黑人社区 A 期心力衰竭患者的护理存在巨大差距，并阻止进展 有症状的心力衰竭。

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.