New Mechanism to Explain Heart Failure Self Management

 描述（由申请人提供）：本申请涉及一项博士研究培训计划，重点是揭示心力衰竭（HF）患者自我管理的神经认知机制。课程，研讨会和研究性学习的计划。凯斯西储大学的研究培训环境为这项培训提供了丰富的资源，包括一个新的P30自我管理研究卓越中心，专注于揭示健康自我管理的大脑行为机制，神经科学实验室和具有强大的心力衰竭自我管理研究计划的教师。 心力衰竭患者必须自我管理他们的慢性疾病，以防止病情加重和住院。自我管理的影响因素已经确定，包括焦虑，抑郁，认知状态，合并症，体力活动和睡眠质量。总的来说，针对这些因素的干预措施并不成功。成功自我管理的一个有前途的认知机制可能是内感受性意识，这是有意识地感知身体刺激的能力，与采取行动有关。如果内感受性意识与自我管理有关，则可以测试旨在提高内感受性意识的干预措施。因此，本研究的目的是检验以下目标：目标1：确定内感受性意识和自我管理维持（坚持限钠、药物和体重监测）与症状管理之间是否存在关联。 目标二：评估影响因素（焦虑、抑郁、认知状态、合并症、身体功能和睡眠质量）对内感受性意识和自我管理维持（坚持限钠、药物和体重监测）与症状管理之间关系的潜在调节作用。 采用描述性横断面研究设计，将从既往研究中招募109例HF患者样本。为了确保该样本中自我管理结果的足够差异，我们将评估既往研究参与者的24小时尿钠水平（钠摄入量的客观指标）。将获得内感受性意识的措施，并评估其与自我管理的关系。该项目将在学生的跨学科导师团队的支持下完成。Dolansky博士在心力衰竭自我管理方面具有先进的知识和经验，Hughes博士在心力衰竭的认知因素方面具有专业知识。

 DESCRIPTION (provided by applicant): This application addresses a doctoral research training program that focuses on uncovering neurocognitive mechanisms of self-management in heart failure (HF) patients. A plan of coursework, seminars, and a research study are presented. The research training environment at Case Western Reserve University provides a rich set of resources for this training, including a new P30 Center of Excellence in Self-Management Research focused on uncovering the brain-behavior mechanisms of self-management of health, a neuroscience lab, and faculty with strong programs of research in heart failure self-management. Heart failure patients must self-manage their chronic disease to prevent exacerbations and hospitalizations. Influencing factors of self-management have been identified and include anxiety, depression, cognitive status, comorbidities, physical activity, and sleep quality. On the whole, interventions that target these factors have been unsuccessful. A promising cognitive mechanism underlying successful self-management may be interoceptive awareness, which is the ability to consciously sense stimuli in the body and is related to taking action. If interoceptive awareness is related to self-management, interventions targeted to increase interoceptive awareness can be tested. Therefore, the purpose of study is to test the following aims: Aim 1: Determine if there is an association between interoceptive awareness and self-management maintenance (adherence to sodium restriction, medication, and weight monitoring) and symptom management. Aim 2: Assess the potential moderating effects of influencing factors (anxiety, depression, cognitive status, comorbidities, physical function, and sleep quality) on the relationship between interoceptive awareness and self-management maintenance (adherence to sodium restriction, medication, and weight monitoring) and symptom management. Using a descriptive cross-sectional study design, a sample of 109 HF patients will be recruited from a prior study. To ensure adequate variance in self-management outcomes in this sample, we will evaluate the 24 hour urine sodium levels (an objective indicator of sodium intake) of participants from the prior study. Measures of interoceptive awareness will be obtained and its relationship to self-management assessed. The project will be completed with support from the student's interdisciplinary mentorship team. Dr. Dolansky has advanced knowledge and experience in heart failure self-management and Dr. Hughes has expertise in cognitive factors in heart failure.