Symptom Biology After Heart Failure Hospitalization

项目总结 本次以患者为导向的研究职业发展奖(K23)申请的目的 是为加州大学博士后研究员乔纳森·奥尔德博士提供额外的研究培训 华盛顿护理学院。申请者的长期目标是独立领导一个 生物行为研究的跨学科团队，并设计R系列研究，指导量身定制的心衰症状 使用生物、行为和临床数据的管理干预。心力衰竭是一种日益严重的 以高症状负担、低生活质量和高医疗保健为特征的心血管疾病 利用率。此外，患者经常难以识别和管理症状。更好地了解如何 患者出院后症状发生变化，心衰症状的生物学基础将提供 需要更早解决症状负担和定制症状管理干预措施的信息 提高生活质量和医疗保健利用率。 该职业发展奖将通过以下途径支持申请者的培训和研究目标 提供与以下内容领域直接相关的指导、课程作业和其他培训活动 在收集、测量和分析心力衰竭生物标志物、症状管理方面的高级培训 对慢性心力衰竭患者的干预，新的远程监测技术的使用，以及职业 发展。本申请中提出的研究项目将检查hf症状的方式和时间。 入院后的变化。申请人提出了一项前瞻性的纵向研究(n=60)，研究对象为患有 心力衰竭住院出院后的高级心力衰竭(NYHA III)。重要的是，我们将使用来自 心脏微机械设备，以更好地了解心衰症状生物学。具体地说，本研究旨在：1) 描述和比较生理和心理症状(呼吸困难、疲劳、疼痛、 抑郁和焦虑)生物标志物(IL-6、肿瘤坏死因子α、NT-ProBNP、Sst2和Galectin-3)与健康相关质量 有无心脏微机械综合征患者的生命超过6个月(出院、1个月、3个月、6个月) 心脏MEMS，2)描述和比较6个月的医疗保健利用情况(药物变化、护士 电话联系、紧急诊所就诊、急诊室就诊、再次住院和死亡) 心脏MEMS组和非心脏MEMS组，以及3)量化心脏MEMS肺之间的关联 6个月以上的动脉压资料、心力衰竭生物标志物、生理和心理症状及HRQOL。 描述性统计、潜在增长曲线建模、并行过程增长曲线建模和多变量 将使用广义线性建模来比较和表征心力衰竭症状轨迹、生物标志物 出院后6个月以上的医疗保健利用轨迹和预测因素。无论是短期还是长期 该职业发展奖的目标与国家护理学院的战略使命相一致 研究了解心力衰竭症状的生物学机制。

PROJECT SUMMARY The purpose of this Mentored Patient-Oriented Research Career Development Award (K23) application is to provide additional research training for Dr. Jonathan Auld, a post-doctoral fellow at the University of Washington School of Nursing. The long-term goals of the applicant are to independently lead an interdisciplinary team in biobehavioral research and to design R-series studies that guide tailored HF symptom management interventions using biological, behavioral and clinical data. Heart failure is a growing cardiovascular disorder that is characterize by high symptom burden, poor quality of life and high healthcare utilization. In addition, patients often struggle to identify and manage symptoms. A better understanding of how symptoms change after patients are discharged and the biological underpinnings of HF symptoms will provide needed information to address symptom burden earlier and to tailor symptom management intervention to improve quality of life and healthcare utilization. This career development award will support the applicant’s training and research goals through the provision of mentorship, coursework, and other training activities directly relevant to the content areas of advanced training in collection, measurement and analysis of HF biomarkers, symptom management interventions for people with chronic HF, the use of novel remote monitoring technology, and career development. The research project proposed in this application will examine how and when HF symptoms change after hospitalization. The applicant proposes a prospective longitudinal study (n=60) of adults with advance HF (NYHA III) after discharge from a HF hospitalization. Importantly, we will use novel data from CardioMEMS devices to better understand HF symptom biology. Specifically, this study aims to: 1) characterize and compare patterns of change in physical and psychological symptoms (dyspnea, fatigue, pain, depression and anxiety) biomarkers (IL-6, TNFα, NT-proBNP, sST2 and Galectin-3) and health-related quality of life over 6 months (discharge, 1 month, 3 months, 6 months) in patients with CardioMEMS and without CardioMEMS, 2) characterize and compare healthcare utilization over 6 months (medication changes, nurse phone contacts, urgent clinic visits, emergency room visits, re-hospitalizations, and mortality) in the CardioMEMS and non-CardioMEMS groups, and 3) quantify the association between CardioMEMS pulmonary artery pressure data, HF biomarkers, physical and psychological symptoms and HRQOL over 6 months. Descriptive statistics, latent growth curve modeling, parallel process growth curve modeling, and multivariate generalized linear modeling will be used to compare and characterize HF symptom trajectories, biomarker trajectories, and predictors of healthcare utilization over 6 months after discharge. Both the short and long-term goals of this Career Development Award align with the strategic mission of The National Institute of Nursing Research to understand the biological mechanisms of HF symptoms.