Fatigue in Heart Failure: A Secondary Data Analysis of the Atherosclerosis Risk in Communities Study

心力衰竭引起的疲劳：社区研究中动脉粥样硬化风险的二次数据分析

• 批准号: 10464036
• 负责人: Noelle Victoria Pavlovic
• 金额: $ 4.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-08-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10464036
• 关键词: Address; Admission activity; Adult; Affect; Age; Annual Reports; Atherosclerosis; Atherosclerosis Risk in Communities; Body mass index; Cardiac; Cardiac Output; Cessation of life; Chronic Disease; Clinical; Complex; Congestive; Congestive Heart Failure; Data Analyses; Diagnostic tests; Disease; Disease Outcome; Distress; EFRAC; Exertion; Family; Fatigue; Foundations; Functional disorder; Funding; Future; Goals; Heart failure; Hospitalization; Individual; Intervention; Investigation; Knowledge; Lead; Left; Liquid substance; Literature; Measures; Modeling; Morbidity - disease rate; Muscle function; National Institute of Nursing Research; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Phenotype; Quality of life; Reporting; Research; Research Design; Risk; Risk Factors; Self Care; Self Management; Severities; Site; Skeletal Muscle; Socioeconomic Status; Strategic Planning; Structure; Symptoms; Syndrome; Testing; United States; United States National Institutes of Health; Ventricular; cardiovascular disorder risk; clinically relevant; common symptom; comorbidity; emotional functioning; empowered; epidemiology study; evidence base; experience; hospital readmission; improved; innovation; mortality; outcome prediction; preservation; prevent; prognostic; programs; prospective; provider intervention; psychologic; respiratory; sex; symptom management; symptom science

Project Summary Heart failure (HF) affects an estimated 6.2 million adults in the United States.1 Importantly, this debilitating syndrome causes significant morbidity and mortality with nearly 80,000 HF-related deaths reported annually.1 Fatigue is a prevalent and distressing symptom for patients with HF and evidence suggests that it has significant prognostic and outcome implications.2,3,4 The presence and increased severity of fatigue in HF increases the risk of hospitalization5,6 and mortality7,8 and is associated with increased depression3,4,9,10, poorer quality of life11,12, worse self-care13, and reduced physical14,15,3, social14, and emotional functioning.16 Fatigue in HF has been characterized in the literature as two types 1) general fatigue and 2) exertional fatigue. 1) general fatigue and 2) exertional fatigue. General and exertional fatigue and their co-occurrence are important to understand because their predictors and associated outcomes may differ. Accurate identification of fatigue type may lead to different interventions to alleviate that fatigue. However, little evidence examines patient reported and clinical outcome differences between general and exertional fatigue, clinically relevant predictors of fatigue have not been identified, and differences in the fatigue experience between HFrEF and HFpEF have not yet been explored. This creates a cap in our understanding of the risk factors for, and associated outcomes of fatigue type in HF. Using a secondary data analysis, this study aims to characterize fatigue types, quantify the relationship between fatigue type and clinical and patient reported outcomes, and examine the cardiac structural and functional predictors of fatigue type in those with HFrEF and HFpEF in the Atherosclerosis Risk in Communities (ARIC) study. This will be accomplished through the following specific aims: AIM 1: Define distinct types of fatigue in individuals with chronic heart failure. AIM 2: Quantify the longitudinal association between fatigue type and HF readmission and mortality and quantify the cross-sectional association between fatigue type and quality of life. AIM 3: Determine the cross-sectional relationship between measures of cardiac structure and function (left ventricular (LV) structure, LV systolic function, LV diastolic function), HF phenotype (HFrEF vs HFpEF), and fatigue type (adjusting for age, sex, socioeconomic status, BMI, comorbidities, and medications). This study will address critical evidence gaps and provide an evidence base for future research to prevent and mitigate the effects of fatigue in HF. It will lay the foundation for a future program of symptom science research investigating multi- dimensional models of HF fatigue symptom science. This study aligns with the National Institute of Nursing Research's strategic plan focus to advance knowledge in symptom science with the goal of developing and testing innovative interventions to alleviate suffering from symptoms and improve quality of life.

项目摘要 据估计，美国有620万成年人患有心力衰竭。1重要的是，这使人虚弱 综合征导致显著的发病率和死亡率，每年有近80,000例与心力衰竭有关的死亡报告。 疲劳是心力衰竭患者普遍而痛苦的症状，有证据表明它有 显著的预后和结果影响。2，3，4心衰患者疲劳的存在和加重 增加住院风险5，6和死亡率7，8，并与抑郁增加3，4，9，10， 更差的生活质量11，12，更差的自我照顾13，身体，15，3，社交和情感功能降低 在文献中，高频下的疲劳被描述为两种类型：1)全身疲劳和2)劳力性疲劳。 1)全身疲劳；2)劳力性疲劳。全身疲劳和劳力性疲劳及其共同出现的情况是 了解这一点很重要，因为它们的预测因素和相关结果可能不同。准确 识别疲劳类型可能会导致不同的干预措施来缓解这种疲劳。然而，几乎没有 证据检查患者报告和临床结果在全身疲劳和劳力性疲劳之间的差异， 临床上与疲劳相关的预测因素尚未确定，疲劳体验的差异 HFrEF和HFpEF之间的关系尚未被探索。这为我们对风险的理解创造了一个上限 心力衰竭患者疲劳型的影响因素及相关结局。使用二次数据分析，本研究的目的是 确定疲劳类型，量化疲劳类型与临床和患者的关系 报道的结果，并检查心脏结构和功能预测疲劳型 在社区动脉粥样硬化风险(ARIC)研究中有HFrEF和HFpEF的患者。这将是 通过以下具体目标实现：目标1：界定患有以下疾病的人的不同类型的疲劳 慢性心力衰竭。目标2：量化疲劳类型与心力衰竭再入院之间的纵向联系 和死亡率，并量化疲劳类型和生活质量之间的横向关联。目标3： 确定心脏结构和功能测量之间的横断面关系(左心室 (LV)结构、LV收缩功能、LV舒张期功能)、HF表型(HFrEF与HFpEF)和疲劳型 (根据年龄、性别、社会经济地位、BMI、合并症和药物进行调整)。这项研究将解决 关键证据差距，并为未来的研究提供证据基础，以预防和减轻 在高频下疲劳。这将为未来的症状科学研究计划奠定基础，调查多 高频疲劳症状科学的维度模型。这项研究与美国国立护理学院的研究结果一致 研究的战略计划侧重于推进症状科学知识，目标是发展和 测试创新干预措施，以缓解症状和提高生活质量。