Symptom Biology After Heart Failure Hospitalization

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PROJECT SUMMARY The purpose of this Mentored Patient-Oriented Research Career Development Award (K23) application is to provide additional research training for Dr. Jonathan Auld, a post-doctoral fellow at the University of Washington School of Nursing. The long-term goals of the applicant are to independently lead an interdisciplinary team in biobehavioral research and to design R-series studies that guide tailored HF symptom management interventions using biological, behavioral and clinical data. Heart failure is a growing cardiovascular disorder that is characterize by high symptom burden, poor quality of life and high healthcare utilization. In addition, patients often struggle to identify and manage symptoms. A better understanding of how symptoms change after patients are discharged and the biological underpinnings of HF symptoms will provide needed information to address symptom burden earlier and to tailor symptom management intervention to improve quality of life and healthcare utilization. This career development award will support the applicant’s training and research goals through the provision of mentorship, coursework, and other training activities directly relevant to the content areas of advanced training in collection, measurement and analysis of HF biomarkers, symptom management interventions for people with chronic HF, the use of novel remote monitoring technology, and career development. The research project proposed in this application will examine how and when HF symptoms change after hospitalization. The applicant proposes a prospective longitudinal study (n=60) of adults with advance HF (NYHA III) after discharge from a HF hospitalization. Importantly, we will use novel data from CardioMEMS devices to better understand HF symptom biology. Specifically, this study aims to: 1) characterize and compare patterns of change in physical and psychological symptoms (dyspnea, fatigue, pain, depression and anxiety) biomarkers (IL-6, TNFα, NT-proBNP, sST2 and Galectin-3) and health-related quality of life over 6 months (discharge, 1 month, 3 months, 6 months) in patients with CardioMEMS and without CardioMEMS, 2) characterize and compare healthcare utilization over 6 months (medication changes, nurse phone contacts, urgent clinic visits, emergency room visits, re-hospitalizations, and mortality) in the CardioMEMS and non-CardioMEMS groups, and 3) quantify the association between CardioMEMS pulmonary artery pressure data, HF biomarkers, physical and psychological symptoms and HRQOL over 6 months. Descriptive statistics, latent growth curve modeling, parallel process growth curve modeling, and multivariate generalized linear modeling will be used to compare and characterize HF symptom trajectories, biomarker trajectories, and predictors of healthcare utilization over 6 months after discharge. Both the short and long-term goals of this Career Development Award align with the strategic mission of The National Institute of Nursing Research to understand the biological mechanisms of HF symptoms.