Improving diagnosis of heart failure with preserved ejection fraction in primary care.

在初级保健中通过保留射血分数改善心力衰竭的诊断。

• 批准号: 10738561
• 负责人: Yulia Khodneva
• 金额: $ 19.23万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-25 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738561
• 关键词: Active Learning; Acute; Affect; Alabama; American; American Heart Association; Award; Cardiology; Caring; Clinic; Clinical; Clinical Data; Clinical Medicine; Collaborations; Communication; Communities; Community Physician; Community Practice; Complement; Complex; Computerized Medical Record; Data; Development; Diagnosis; Diagnostic; Doctor of Philosophy; EFRAC; Early Diagnosis; Echocardiography; Education; Elderly; Enrollment; Epidemiology; European; Focus Groups; Functional disorder; Funding; Future; General Practices; Glucose; Goals; Grant; Guidelines; Health; Health Services Research; Heart Rate; Heart failure; Hospitalization; Internist; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning Module; Light; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Newly Diagnosed; Outcome; Parents; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Pragmatic clinical trial; Prevalence; Primary Care; Process; Program Development; Prospective Studies; Publishing; Pulmonary Hypertension; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Priority; Resources; Review Literature; Risk; Risk Factors; Role; Series; Societies; Sodium; Structure; Surveys; Testing; Time; Training; Update; acceptability and feasibility; arm; care outcomes; career development; clinical diagnostics; college; comorbidity; cost; demographics; design; diagnostic criteria; diagnostic strategy; efficacy testing; experience; feasibility testing; future implementation; health care delivery; implementation science; improved; improved outcome; inhibitor; innovation; intervention mapping; mortality; novel; pilot test; point of care; poor health outcome; practice-based research network; preference; preservation; primary care provider; primary outcome; provider factors; provider-level barriers; recruit; research study; skill acquisition; skills; symporter; therapy development; treatment guidelines; urban area

ABSTRACT Heart failure affects 6 million people in the US, resulting on 1 million hospitalizations and a cost of over $30 billion per year. Heart failure with preserved election fraction (HFpEF) accounts for half of these cases, and its prevalence is rising by 1% annually. About 20-30% of HFpEF cases remain undiagnosed, contributing to poor health outcomes for these patients. Preliminary data suggest that primary care providers (PCPs) are often unaware of diagnostic and treatment guidelines for HFpEF. At the same time, primary care has an invaluable potential to improve HFpEF health outcomes by facilitating early diagnosis, referral to cardiology, and treating HFpEF comorbidities. The objective of this proposal is to design and test a novel intervention that will educate PCPs about HFpEF and provide them with a clinical diagnostic decision support aide (CDDSA) that is based on a validated diagnostic score for HFpEF. The overall hypothesis of this project is that if PCPs can detect HFpEF earlier, and therefore, refer patients to cardiology, and manage their comorbidities, it can help improve outcomes in HFpEF. Building on established community-academic collaborations, this project will be conducted with the help of the Alabama Practice-Based Research Network (APBRN). This project will include identification of provider barriers to HFpEF diagnosis among PCPs via an interview and a survey that will measure the prevalence of HFpEF knowledge gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational session and CDDSA to optimize HFpEF diagnosis in primary care (Aim 2); and a pilot study to test the feasibility and acceptability of the CDDSA (Aim 3). At the completion of the pilot study in Aim 3, the intervention will be ready to be tested at a larger scale (e.g., R-series grant) to evaluate its efficacy. The candidate for this career development award, Yulia Khodneva, MD, PhD, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills necessary for her transition to independence focusing her research on improving healthcare delivery, and outcomes for HFpEF patients. Specifically, Dr. Khodneva will receive training in intervention development, implementation science, and conducting of pragmatic clinical trials, designed to improve healthcare delivery and outcomes for HFpEF patients. Dr. Khodneva will be mentored by two NHLBI-funded physician- investigators, Andrea Cherrington, MD (primary mentor; expert in intervention development and pragmatic clinical trials), Pankaj Arora, MD, (co-mentor; expert in HFpEF diagnosis and HFpEF echocardiography), and Larry Hearld, PhD (co-mentor; expert in implementation science). The combination of mentorship, formal coursework, and the proposed experiential learning during the project’s 5-year integrated training and research plan will position Dr. Khodneva to become an independent investigator while advancing the field of primary care for HFpEF patients.

摘要 心力衰竭影响美国600万人，导致100万人住院治疗，费用超过30美元 每年10亿。保留选择分数的心力衰竭（HFpEF）占这些病例的一半， 患病率每年上升1%。大约20-30%的HFpEF病例仍未确诊，导致了贫困。 这些患者的健康状况。初步数据表明，初级保健提供者（PCP）往往是 不了解HFpEF的诊断和治疗指南。与此同时，初级保健具有宝贵的 通过促进早期诊断、转诊至心脏科和治疗，改善HFpEF健康结局的潜力 HFpEF合并症。本提案的目的是设计和测试一种新的干预措施， PCPs关于HFpEF，并为他们提供基于以下内容的临床诊断决策支持辅助工具（CDDSA）： HFpEF的有效诊断评分。本项目的总体假设是，如果PCP可以检测HFpEF， 因此，尽早将患者转诊至心脏科，并管理其合并症，可以帮助改善结局 在HFpEF中。在已建立的社区-学术合作的基础上，该项目将与 亚拉巴马基于实践的研究网络（APBRN）的帮助。该项目将包括确定 通过访谈和调查，提供者对PCP中HFpEF诊断的障碍， HFpEF知识差距和干预偏好（目标1）的患病率; 设计教育课程和CDDSA的过程，以优化初级保健中的HFpEF诊断（目标2）; 进行先导研究，以测试社区发展支援计划的可行性和可接受程度（目标3）。试点研究完成后， 目标3，干预措施将准备好进行更大规模的测试（例如，R系列补助金），以评估其功效。 这个职业发展奖的候选人，尤利娅Khodneva，医学博士，博士，是一个具有专业知识的普通内科医生 临床医学、流行病学和卫生服务研究。这个奖项将使她获得技能 这是她向独立过渡的必要条件，她的研究重点是改善医疗保健服务， HFpEF患者的结局。具体而言，Khodneva博士将接受干预发展方面的培训， 实施科学，并进行务实的临床试验，旨在改善医疗保健服务， HFpEF患者的结局。霍德涅瓦博士将由两名NHLBI资助的医生-研究人员指导， Andrea Cherrington，医学博士（主要导师;干预开发和实用临床试验专家）， Pankaj Arora，医学博士（共同导师; HFpEF诊断和HFpEF超声心动图专家）和Larry Hearld， 博士（共同导师;执行科学专家）。导师制、正式课程和 在该项目的5年综合培训和研究计划中提出的体验式学习将定位博士。 Khodneva将成为一名独立的研究者，同时推进HFpEF患者的初级保健领域。