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

摘要 在美国，心力衰竭影响了600万人，导致100万人住院，花费超过30美元 每年10亿美元。心力衰竭伴保留的电子分数(HFpEF)占这些病例的一半，其 患病率正以每年1%的速度增长。大约20%-30%的HFpEF病例仍未得到诊断，导致贫困 这些患者的健康结果。初步数据显示，初级保健提供者(PCP)通常 不了解HFpEF的诊断和治疗指南。与此同时，初级保健具有不可估量的价值 通过促进早期诊断、心内科转诊和治疗来改善HFpEF健康结局的潜力 HFpEF合并症。这项建议的目标是设计和测试一种新的干预措施，将教育 并为他们提供基于以下内容的临床诊断决策辅助工具(CDDSA) HFpEF的有效诊断评分。该项目的总体假设是，如果PCP可以检测到HFpEF 因此，及早将患者转介到心脏科，并处理他们的合并症，有助于改善预后 在HFpEF中。在已建立的社区与学术合作的基础上，该项目将与 阿拉巴马州实践研究网络(APBRN)的帮助。该项目将包括确定 通过一次访谈和一项调查，提供者在初级保健医生中诊断HFpEF方面存在障碍 HFpEF知识差距和干预偏好的流行率(目标1)；利益攸关方参与 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)； 开展试点研究，以测试CDDSA的可行性和可接受性(目标3)。在#年的试验研究完成后 目标3，该干预措施将准备在更大范围内进行测试(例如，R系列赠款)，以评估其效果。 这一职业发展奖的候选人，Yulia Khodneva，医学博士，是一名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。 是她向独立过渡所必需的，她的研究重点是改善医疗保健服务，以及 HFpEF患者的预后。具体地说，霍德涅瓦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，旨在改善医疗保健提供和 HFpEF患者的预后。Khodneva博士将由两名由NHLBI资助的医生兼研究人员指导， 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 HELD. 博士(共同导师；实施科学专家)。导师指导、正式课程和 在该项目的5年综合培训和研究计划期间提出的体验式学习将使Dr。 Khodneva将成为一名独立的研究员，同时推动HFpEF患者的初级保健领域。

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.