Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF)

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PROJECT SUMMARY While heart failure (HF) is the fastest growing cardiovascular condition in the U.S., about half of adults with HF are also considered physically frail. In recent years, there is a better understanding of the intersection of physical frailty with HF, including the strong association between physical frailty and worse patient-reported and clinical outcomes in HF. Additionally, evidence shows that physical frailty affects women more than men in HF. However, there is a lack of understanding of how physical frailty is associated with adverse outcomes, which hinders our ability to develop and deploy effective biobehavioral interventions to mitigate these adverse outcomes. While there has been work characterizing the biological profile of physical frailty in HF, the behavioral profile has not been characterized from either a quantitative or qualitative perspective. One key behavior that adults with HF must engage in is symptom monitoring and management (SMM). Monitoring for HF symptoms and engaging in decision-making to address these symptoms (e.g. recognizing dyspnea on exertion and calling a provider) are important behaviors that reduce adverse patient-reported and clinical outcomes. Physical frailty, however, may impact SMM behaviors by blunting the monitoring of symptoms and hindering the management of symptoms, resulting in adverse outcomes. Understanding the relationship of physical frailty with SMM behaviors may characterize the behavioral profile of physically frail adults with HF, offer one possible explanation by which physical frailty affects outcomes in HF, and provide a means of developing and deploying effective biobehavioral interventions to address physical frailty in HF, our long-term goal. Therefore, the objectives of this exploratory study are to 1) characterize the relationship between physical frailty, SMM behaviors, and outcomes, and 2) identify SMM behaviors, aligned with the patient's perspective, to target with biobehavioral interventions. The proposed study utilizes a sequential mixed methods approach wherein in Phase 1, we will collect cross-sectional quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we will collect qualitative data from ~32-40 adults with the following aims: 1) quantify associations among physical frailty, SMM behaviors, and outcomes in adults with HF; 2) describe the experience of SMM behaviors for physically frail and non- physically frail adults with HF; and 3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. Accomplishing this state-of-the-art study is an important stepping stone towards the development of larger proposals. Specifically, it will allow our team to merge our understanding of physical frailty from a biological perspective with that of a behavioral perspective to develop biobehavioral interventions to mitigate the adverse patient-reported and clinical outcomes associated with physical frailty in HF.