ACHIEVE P2 - 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危险因素，占所有新病例的一半以上。此外，黑人成年人有 与白人成年人相比，高血压患心力衰竭的风险要大得多，可能是白人的20倍。 因此，预防心力衰竭的早期干预，特别是血压(BP)的控制是至关重要的。然而， 在黑人社区中，有效治疗的实施仍然是次优的，特别是在低收入 收入城市环境。虽然涉及的因素很多，但越来越多的证据表明，不利的社会 健康决定因素(SDoH)，如获得医疗保健的机会较少、食品不安全以及缺乏安全的地方 体力活动是实施推荐疗法的关键障碍。为了达到健康 在公平的情况下，必须制定改进的战略，以克服这些负面的SDoH。为了更好地参与我们的风险投资 社区，我们的团队开发了一个创新的移动医疗单位(MHU)计划，它使用地理空间健康 和社会脆弱性数据，将卫生服务定向到最需要的社区，否则他们可能不会 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，还提供已被证明可以降低心力衰竭的药物 发病率。特别是，钠-葡萄糖转运体2型(SGLT2)的抑制剂可以预防心衰和肾功能丧失 高危患者的功能和最近的数据表明，黑人患者的益处增强。然而，这些都是 在黑人中极大地未得到充分利用，进一步加剧了健康差距。在实现的项目2中 大(在大湖区通过早期预防解决心脏代谢健康不平等问题) 将使用一项务实、随机、非盲目的临床试验来实施和测试一种利用 我们的MHU平台可改善护理获取途径，并增强黑人之间的协作护理交付 A期心力衰竭患者(定义为无症状的人，有已知的前置条件，如 高血压是晚期临床心衰的高危人群)。我们计划的主要组成部分是1)a) 由社区卫生工作者进行个性化干预，通过联系患者来解决SDoH问题 有可用的社区和社会资源，以及2)每年由药剂师指导的治疗优化 标准化的GDMT协议。这一干预将解决多个领域和影响程度，以减少 黑人社区在照顾A期心力衰竭患者方面的巨大差距，并阻止进展到 有症状的心衰。

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.