Understanding and addressing risks of low socioeconomic status and diabetes for heart failure

了解和解决低社会经济地位和糖尿病导致心力衰竭的风险

• 批准号: 10494185
• 负责人: Chiadi E Ndumele
• 金额: $ 69.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494185
• 关键词: Address; Diabetes Mellitus; Heart failure; Risk; cardiometabolism; health equity; low socioeconomic status

Summary Heart failure (HF) is associated with high morbidity, mortality and costs, and there is great interest in refining strategies to reduce HF risk. Diabetes (DM) and low socioeconomic status (SES) are each independent risk factors for HF, and both factors together have a synergistic association with incident HF. A major functional consequence of these associations is impaired cardiorespiratory fitness, with implications for prognosis and quality of life. Additionally, low SES and DM are over-represented among racial and ethnic minorities and therefore a cause of HF disparities. Strategies to address the high HF risk associated with the combination of low SES and DM will require a focus on social determinants of health. Problem-solving training and community health worker (CHW) support are effective in overcoming barriers to care, and improving lifestyle, DM self- management, health system engagement and risk factor control, but they have not yet been applied to addressing HF risk. Prevention efforts would be further informed by understanding geographic disparities in HF risk and elucidating clinical risk factors that might serve as targets for intervention. We therefore propose a randomized trial among 350 persons with low SES, DM, obesity and early cardiac dysfunction, testing the effects of a multi-level intervention of problem-solving training, CHW support and partnership with community facilities to support lifestyle change on fitness, risk factor control, markers of cardiac injury/fibrosis and quality of life. We propose: Aim 1: To use electronic medical record data to a) compare the association of neighborhood SES with incident HF in patients with DM, across urban, rural and suburban settings, and b) to identify modifiable clinical risk factors for HF associated with DM that are more prevalent in persons with low SES. Aim 2: To adapt an evidence-based, pragmatic intervention to improve functional status and risk factor control in persons with low SES, DM, obesity and early cardiac dysfunction, using community-based participatory research (CBPR) and patient-centered outcomes research (PCOR) principles. Aim 3: To test, in a randomized controlled trial, if a 1-year multilevel intervention of problem-solving training, CHW use to enhance social support and health system engagement, and use of community facilities to support lifestyle change improves cardiorespiratory fitness and related outcomes in those with low SES, DM, obesity and early cardiac dysfunction, more than enhanced education and connection with community health programs. This work will elucidate strategies to address HF risk related to low SES and DM, which are key contributors to HF disparities.

总结 心力衰竭（HF）与高发病率、死亡率和成本相关，并且存在对精炼的极大兴趣 降低HF风险的策略。糖尿病（DM）和低社会经济地位（SES）是各自独立的风险 HF的因素，并且两个因素一起与HF事件具有协同关联。主要功能 这些关联的后果是心肺功能受损，对预后和 生活质量此外，低社会经济地位和糖尿病在少数种族和族裔中的比例过高， 因此是HF差异的原因。解决与以下组合相关的高HF风险的策略 低社会经济地位和糖尿病将需要关注健康的社会决定因素。解决问题的培训和社区 卫生工作者（CHW）支持在克服护理障碍、改善生活方式、DM自我 管理、卫生系统参与和风险因素控制，但尚未应用于 应对HF风险。通过了解HF的地理差异，将进一步了解预防工作 风险和阐明可能作为干预目标的临床风险因素。因此，我们建议 在350名低SES、DM、肥胖和早期心功能不全患者中进行的随机试验， 解决问题培训、社区卫生工作支持和与社区合作的多层次干预的效果 支持生活方式改变的设施，包括健身、风险因素控制、心脏损伤/纤维化标志物和质量 生命我们提出：目的1：使用电子病历数据，a）比较 在城市、农村和郊区环境中，DM患者发生HF的社区SES， 和B）确定与DM相关的HF的可改变的临床风险因素， 社会经济地位低的人。目标2：采用循证、务实的干预措施， 低SES、DM、肥胖和早期心脏病患者的功能状态和危险因素控制 功能障碍，使用基于社区的参与性研究（CBPR）和以患者为中心的结果 变革和组织振兴方案（变革和组织振兴方案）原则。目标3：在随机对照试验中测试1年多水平是否 问题解决训练、CHW用于增强社会支持和卫生系统干预 参与和使用社区设施来支持生活方式的改变， 低SES、DM、肥胖和早期心功能不全患者的健康和相关结局， 而不是加强教育和与社区健康项目的联系。这项工作将阐明 解决与低SES和DM相关的HF风险的策略，这是HF差异的关键因素。