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

项目总结 虽然心力衰竭(HF)是美国增长最快的心血管疾病，但大约一半的成年人患有HF 也被认为身体虚弱。近年来，人们对物理学的交叉有了更好的理解 心力衰竭的虚弱，包括身体虚弱与患者病情恶化之间的强烈关联--报告和临床 以HF表示的结果。此外，有证据表明，在HF中，身体虚弱对女性的影响比男性更大。然而， 对身体虚弱如何与不良后果相关缺乏了解，这阻碍了我们的 开发和部署有效的生物行为干预措施以减轻这些不良后果的能力。而当 已经有工作描述了心力衰竭身体虚弱的生物学特征，但行为特征还没有。 无论是从数量上还是从质量上看，都有其特点。患有心力衰竭的成年人的一个关键行为 必须从事的是症状监测和管理(SMM)。监测心力衰竭症状并参与 解决这些症状的决策(例如，识别劳累时的呼吸困难和打电话给提供者)是 减少不良患者报告和临床结果的重要行为。然而，身体虚弱可能会 影响SMM行为，削弱症状监测，阻碍症状管理， 导致了不利的后果。了解身体虚弱与SMM行为的关系可能 描述患有心力衰竭的身体虚弱的成年人的行为特征，提供一种可能的解释 身体虚弱影响心力衰竭的结局，并为开发和部署有效的生物行为提供了一种手段 我们的长期目标是通过干预措施解决心力衰竭患者的身体虚弱问题。因此，这次探索性的目标是 研究的目的是：1)描述身体虚弱、SMM行为和结果之间的关系；2) 确定SMM行为，与患者的观点一致，以生物行为干预为目标。这个 建议的研究采用顺序混合方法，在第一阶段，我们将收集横断面数据 定量数据来自120名成人心力衰竭患者的性别平衡样本，在第二阶段，我们将收集定性的 来自大约32-40名成年人的数据，目的如下：1)量化身体虚弱、SMM行为、 2)描述体弱者和非体弱者SMM行为的经历 3)确定身体虚弱和非身体虚弱的SMM行为需求 患有心力衰竭的虚弱成年人。完成这项最先进的研究是迈向 制定更大的提案。具体地说，这将使我们的团队融合我们对身体虚弱的理解 从生物学的角度和行为的角度开发生物行为干预措施 减轻与心力衰竭患者身体虚弱相关的不良患者报告和临床结果。

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.