Profiling the Heterogeneous Response of Exercise therapy in HF patients

分析心力衰竭患者运动疗法的异质反应

• 批准号: 8455363
• 负责人: Ruth Marie Masterson Creber
• 金额: $ 4.22万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8455363
• 关键词: Address; Adult; Advocate; Authorization documentation; Behavior; Behavioral; Biological; Biological Markers; Biology; Cardiac; Caregivers; Clinical; Complex; Control Groups; Data; Data Set; Discipline; Discipline of Nursing; Disease; Exercise; Fellowship; Funding; Goals; Grant; Growth; Health; Heart failure; Hospitalization; Individual National Research Service Award; Inflammation; Intervention; Investments; Knowledge; Lead; Learning; Medicare; Mental Depression; Methodology; Methods; Mission; Modeling; Myocardial; National Institute of Nursing Research; National Research Service Awards; Nurses; Outcome; Pathogenesis; Patient Care Planning; Patients; Pattern; Physical therapy exercises; Physiological; Principal Investigator; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Research; Research Personnel; Research Support; Research Training; Science; Scientist; Self Management; Serum; Specialist; Specific qualifier value; Stress; Subgroup; Symptoms; Testing; Training; Transplantation; United States National Institutes of Health; Universities; Vulnerable Populations; Walking; Work; control trial; evidence base; functional disability; health related quality of life; improved; innovation; interdisciplinary collaboration; lifestyle intervention; meetings; mortality; parallel processing; patient population; pre-doctoral; programs; response; skills; sound; treatment planning

DESCRIPTION (provided by applicant): The purpose of this individual National Research Service Award (NRSA) application is to provide research training for a nurse to become an independent investigator focusing on how exercise therapy, defined as routine exercise lasting at least 8 weeks, in the heart failure (HF) patient population impacts the parallel processes of physiologic and symptom changes and influences HF patients' outcomes. In addition to supporting scholarly coursework, acquiring methodological and statistical skills, and learning to conduct ethically sound research with vulnerable populations, this NRSA training grant will also support research to explain the heterogeneous response to exercise therapy in the HF patient population. From a clinical perspective, there is huge potential for exercise therapy to be better integrated into patient care plans and be reimbursed by Medicare. Further understanding of who benefits most is first needed. I hypothesize that there are common and distinct responses to exercise therapy in the HF patient population that can be identified, predicted, and quantified in association with health outcomes. I will investigate this hypothesis empirically using a subgroup of patients from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) dataset. I have received special permission to use the dataset, including biomarker, symptom and outcome data from the principal investigators of the study: Dr. Christopher O'Connor and Dr. David Whellan. My research training will be guided by my sponsor and co- sponsor who are two internationally known HF scientists, Dr. Barbara Riegel, a well-known HF nurse expert and leader, and Dr. Kenneth Margulies, a highly acclaimed HF transplant specialist. This project will also receive significant input from Dr. Christopher Lee, a nurse scientist, advanced methodologist and consultant on this project. The long-term impact of this research training is important because exercise training is a self-management behavior strongly encouraged but under-used in the HF patient population. This research is closely assigned with the priorities of the National Institute of Nursing Research, which specify the need to investigate multiple determinants of health and the impact they have on patients' ability to self-manage their disease, manage their symptoms and improve their health-related quality of life. This work will lead to knowledge of whom to target with specific tailored exercise interventions. The specific research and methodological approach proposed in this application has wide applicability to many stakeholders, including professionals, caregivers and patients with HF. PUBLIC HEALTH RELEVANCE: The focus of my pre-doctoral training is on becoming an independent nurse investigator. The research component of this fellowship focuses on characterizing the heterogeneous physiologic and symptom responses to exercise therapy in HF patients using growth mixture modeling. Although exercise therapy is known to be safe in the HF patient population, it is not routinely incorporated into patients' treatment plans because the symptom-biology mechanisms are not well characterized or understood. Although many clinicians advocate referral to Cardiac Rehabilitation, Medicare does not reimburse it. The proposed research will dissect the heterogeneous responses to exercise therapy (by characterizing them in terms of distinct trajectories) and identify select subpopulations of HF patients who demonstrate favorable responses. The longer-term implication is to be able to provide the scientific evidence to support advocating for Medicare reimbursement for HF patients who will benefit most from exercise therapy.

描述（由申请人提供）：本次国家研究服务奖（NRSA）个人申请的目的是为一名护士提供研究培训，使其成为一名独立的研究者，重点关注心力衰竭（HF）患者群体中运动治疗（定义为持续至少8周的常规运动）如何影响生理和症状变化的平行过程，并影响HF患者的预后。除了支持学术课程，获得方法学和统计技能，以及学习在弱势群体中进行合乎伦理的研究外，NRSA培训资助还将支持解释心力衰竭患者群体对运动治疗的异质反应的研究。从临床角度来看，将运动疗法更好地纳入患者护理计划并由医疗保险报销的潜力巨大。首先需要进一步了解谁受益最多。我假设，在心力衰竭患者人群中，运动治疗有共同的和不同的反应，可以识别、预测和量化与健康结果的关联。我将使用心力衰竭患者亚组和运动训练结果调查对照试验（HF-ACTION）数据集来实证研究这一假设。我已经获得了使用该数据集的特别许可，包括该研究的主要研究者克里斯托弗·奥康纳博士和大卫·惠伦博士提供的生物标志物、症状和结果数据。我的研究培训将由两位国际知名的心衰科学家Barbara Riegel博士和Kenneth Margulies博士指导，他们是知名的心衰护理专家和领导者，以及备受赞誉的心衰移植专家。本计划亦会得到香港大学的李焯芬博士的大力支持