ENABLE: CHF-PC (Comprehensive Heartcare For Patients and Caregivers)

 描述（由申请人提供）： 近500万美国人，大多数年龄超过65岁，患有心力衰竭（HF）。尽管治疗进展，50%将在5年内死亡;年龄增加和农村环境是与最大HF发病率和死亡率相关的风险因素。在死亡前一年，HF患者将经历多次住院治疗以及未缓解的身体和情感痛苦的个人和经济成本。目前，只有19%的医疗保险年龄的HF患者（及其家庭照顾者）获得有益的姑息治疗服务，而超过一半的晚期癌症患者。老年HF患者及其护理人员很少能够获得姑息性支持性护理服务，因为该疾病是不可预测的，并且在尝试其他药物治疗之前可能无法提供姑息性治疗。我们和其他人已经证明，在晚期癌症中，并行姑息治疗在生活质量（QOL），症状负担，抑郁症和某些情况下的生存率方面取得了有益的结果。该干预措施改编自我们成功的癌症姑息治疗模式（ENABLE：教育，培育，建议，生命结束前）。我们的总体目标是测试并发HF姑息治疗模式在降低晚期HF患者发病率方面的有效性。这项随机对照试验（RCT）将比较380名NYHA III/IV级HF老年人和228名护理人员的生活质量、症状负担、情绪以及慢性病和临终护理质量。一半的患者参与者（n=190）将随机接受干预，另一半（n=190）将接受常规HF治疗。随机对照试验的具体目标;启用：CHF-PC（患者和护理人员的综合心脏护理），1）确定ENABLE：CHF-PC是否导致晚期HF患者报告的QOL和情绪更高（抑郁/焦虑）;和较低的症状负担和资源使用（例如，入院和住院天数、急诊访视），以及2）确定ENABLE是否：CHF-PC导致基线后8周和16周时患者报告的QOL、情绪（焦虑/抑郁）和自我报告的健康状况更高，护理人员负担更低。这项研究与公共卫生的相关性在于，迫切需要改善农村地区老年人的常规护理，这些老年人患有晚期心力衰竭及其照顾者。这项研究将大大有助于这一努力。

 DESCRIPTION (provided by applicant): Almost 5 million Americans, most over age 65, carry a diagnosis of heart failure (HF). Despite treatment advances, 50% will die within 5 years; increasing age and rural environment are risk factors associated with the greatest HF morbidity and mortality. In the year before death, HF patients will experience multiple hospitalizations and personal and economic costs of unrelieved physical and emotional suffering. Currently, only 19% of Medicare-aged HF patients (and their family caregivers) access beneficial palliative care services, compared with more than half of advanced cancer patients. Older patients with HF and their caregivers, rarely have access to palliative supportive care services because the disease is unpredictable and palliative treatment may not be provided until after other medical treatments have been tried. We and others have demonstrated in advanced cancer that concurrent palliative care achieves beneficial outcomes in quality of life (QOL), symptom burden, depression, and in some case survival. The intervention is adapted from our successful palliative care model for cancer (ENABLE: Educate, Nurture, Advise, Before-Life- Ends). Our overall goal is to test the efficacy of a concurrent HF palliative care model in reducing the morbidity of living with advanced HF. This randomized controlled trial (RCT) will compare the quality of life, symptom burden, mood, and the quality of chronic illness and end-of-life care in 380 older adults with NYHA stage III/IV HF and 228 caregivers. Half of the patient participants (n=190) will be randomized to the intervention and half (n=190) will receive usual HF care. The specific aims of the RCT; ENABLE: CHF-PC (Comprehensive Heart care for Patients and Caregivers), are to 1) Determine whether ENABLE: CHF-PC leads to higher advanced HF patient-reported QOL and mood (depression/anxiety); and lower symptom burden and resource use (e.g. hospital admissions and days, emergency visits) at 8 and 16 weeks after baseline and to 2) Determine whether ENABLE: CHF-PC leads to higher caregiver-reported QOL, mood (anxiety/depression), and self-reported health and lower caregiver burden at 8 and 16 weeks after baseline. The relevance of this research to public health is that there is an urgent need to improve the routine care of older adults in rural areas with advanced heart failure and their caregivers. This study will contribute substantially to that effort.