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 心力衰竭（HF）影响着美国约620万成年人。1重要的是， 综合征导致显著的发病率和死亡率，每年报告近80，000例HF相关死亡。 疲劳是HF患者的普遍和令人痛苦的症状，有证据表明， 显著的预后和结果影响。2，3，4 HF患者疲劳的存在和严重程度增加 增加住院风险5，6和死亡率7，8，并与抑郁症增加相关3，4，9，10， 生活质量下降11，12，自我护理下降13，身体功能下降14，15，3，社交功能下降14，情感功能下降16。 HF中的疲劳在文献中被描述为两种类型：1）全身疲劳和2）劳力性疲劳。 1)一般性疲劳和2）劳力性疲劳。全身性疲劳和劳力性疲劳及其同时发生是 重要的是要理解，因为它们的预测因素和相关的结果可能不同。准确 疲劳类型识别可以导致不同的干预以减轻疲劳。不过小 证据检查患者报告和临床结果之间的差异，一般和劳力性疲劳， 疲劳的临床相关预测因素尚未确定，疲劳体验的差异 HFrEF和HFpEF之间的关系尚未研究。这在我们对风险的理解上创造了上限 HF患者疲劳类型的影响因素和相关结果。通过二次数据分析，本研究旨在 表征疲劳类型，量化疲劳类型与临床和患者之间的关系 报告的结果，并检查疲劳类型的心脏结构和功能预测因素， 社区动脉粥样硬化风险（ARIC）研究中的HFrEF和HFpEF患者。这将是 通过以下具体目标完成：目的1：定义不同类型的疲劳在个人与 慢性心力衰竭目的2：量化疲劳类型与HF再入院之间的纵向关联 和死亡率，并量化疲劳类型和生活质量之间的横截面关联。目标3： 确定心脏结构和功能（左心室）测量之间的横截面关系 (LV)结构、LV收缩功能、LV舒张功能）、HF表型（HFrEF vs HFpEF）和疲劳类型 （调整年龄、性别、社会经济地位、BMI、合并症和药物）。这项研究将解决 关键的证据差距，并为未来的研究提供证据基础，以防止和减轻 HF疲劳它将为未来调查多症状的症状科学研究计划奠定基础。 HF疲劳症状科学的三维模型。这项研究与美国国家护理研究所（National Institute of Nursing 研究的战略计划重点是推进症状科学的知识， 测试创新的干预措施，以减轻症状和改善生活质量。