The Symmetry-HF Study: Symptom Dynamics and Clinical Biomarkers of Heart Failure in Older Adult Care Dyads After Heart Failure Hospitalization

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PROJECT SUMMARY Heart failure (HF) is a devastating public health issue for America's aging population. It is the primary reason for hospital admission for older adults, and HF hospitalization for older adult patients carries a much higher burden of subsequent clinical events (rehospitalization and death) than it holds for younger patients. HF hospitalization is also associated with concerning outcomes for family caregivers, particularly spouses/partners, who experience higher degrees of caregiver strain (i.e. burden) and higher mortality risk after their loved one is hospitalized. Given that worsening symptoms are the primary driver of HF hospitalizations, and timely symptom response is critical for maintaining clinical stability, a major focus of research has been reducing HF readmissions by targeting HF patient symptom monitoring and response. However, multiple large HF symptom monitoring trials have been inconsistently successful in improving patient outcomes post-discharge. Moreover, these studies rarely include family caregivers, despite the fact that caregivers play a major role in managing symptoms, and they themselves experience poor health outcomes related to patient hospitalization. The overall scientific goal of this proposal is to address this critical knowledge gap by examining how patients and their caregiving partners monitor symptoms together, and testing the overall hypothesis that patients and caregivers who assess symptoms similarly, and whose assessments accurately reflect changes in clinical stability, will have better symptom response and better individual and dyadic outcomes. We will enroll 50 older adults hospitalized for HF and their caregiving spouse/partner for a daily diary study of symptoms and clinical biomarkers of HF progression, and follow them during the high risk post-discharge period (5 weeks). Leveraging intensive approaches for modeling dyadic dynamics, we will: (1) Characterize agreement in patient and caregiver assessments of patient HF symptoms during the post-discharge period; (2) Determine whether agreement in patient and caregiver HF symptom assessments predicts patient event-risk, caregiver strain, and dyadic symptom response and health status; and (3) Describe how patient and caregiver symptom assessments change in relation to clinical biomarkers of HF congestion, and whether triangulating symptom assessments with clinical biomarkers identifies high risk dyadic patterns of symptom monitoring. This proposed research will be conducted in a resource-rich environment, which includes an NIH-funded Clinical and Translational Science Center and numerous other institutional and mentor resources for conducting HF research in older adult couples. The execution of this study, coupled with a comprehensive training plan (formal coursework, workshops, hands-on and immersion experiences, one-on-one training), supports the career development goal of this award, which is to provide the Candidate with the skills necessary (intensive dyadic longitudinal designs and analysis, integration of clinical biomarkers) to transition to scientific independence and facilitate her long-term goal of developing a sustainable, innovative program of research to improve the health of patients and caregivers as they manage HF together.