Improving the Health Status of Individuals with Type 2 Myocardial Infarction

改善 2 型心肌梗死患者的健康状况

• 批准号: 10619099
• 负责人: Cian Patrick McCarthy
• 金额: $ 19.64万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-09 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619099
• 关键词: Acute myocardial infarction; Adoption; Affect; Appointment; Award; Benefits and Risks; Cardiac rehabilitation; Cardiovascular system; Characteristics; Clinical; Clinical Trials; Clinical Trials Design; Data; Diagnosis; Dimensions; Electronic Mail; Enrollment; Event; Evidence based treatment; Exercise; Foundations; Frequencies; Goals; Guidelines; Health; Health Status; Health system; Heart failure; Individual; Intervention; Investigation; Knowledge; Leadership; Learning; Measures; Mental Depression; Mentors; Mentorship; Myocardial; Myocardial Infarction; Myocardial Ischemia; Necrosis; New England; Outcome; Outcome Measure; Oxygen; Patient Outcomes Assessments; Patients; Pattern; Perception; Persons; Physical Function; Physical Performance; Physicians; Physiological; Positioning Attribute; Prevalence; Prognosis; Published Comment; Quality of life; Questionnaires; Randomized; Recommendation; Recurrence; Reporting; Research; Research Design; Research Personnel; Research Proposals; Risk; Role; Rupture; Safety; Stress; Surveys; Testing; Training; Translating; United States; United States National Institutes of Health; Writing; adjudication; cancer type; career; clinical trial implementation; cohort; comorbidity; coronary plaque; design; effectiveness/implementation hybrid; effectiveness/implementation trial; experience; frailty; health difference; high risk population; implementation science; implementation/effectiveness; improved; improved outcome; mortality; multi-component intervention; myocardial injury; patient engagement; programs; prospective; randomized, clinical trials; research study; smartphone application; treatment as usual; treatment strategy; virtual

Project Abstract Acute myocardial infarction (MI) is characterized by myocardial necrosis due to coronary ischemia and may be precipitated by several mechanisms. Coronary plaque rupture causes ‘type 1 MI,’ the subject of intense investigation for several decades and now with several therapies demonstrated to reduce mortality and improve health status. However, it is now recognized that at least 1 in 5 MIs are ‘type 2 MI,’ which occurs due to a mismatch in myocardial oxygen supply/demand precipitated by a preceding physiologic stress. Persons with type 2 MI are usually older and have more comorbidities than persons with type 1 MI. However, it is unknown whether these characteristic differences translate to differences in health status. Type 2 MI is associated with a poor prognosis; only 40% of individuals are alive at 5 years. Unfortunately, despite the frequency and prognosis of type 2 MI, evidence-based treatment strategies are lacking due to an absence of clinical trials. Exercise-based cardiac rehabilitation (CR) is demonstrably efficacious for type 1 MI. However, CR is virtually unused for type 2 MI. Increasing adoption of CR, a covered therapy, may improve outcomes for persons with type 2 MI. The aims of this research proposal are to (1) determine if differences exist in patient- reported health status between persons with type 2 versus type 1 MI, (2) obtain key information from patients and clinicians on the perceived benefits, acceptability, evidence requirement, and barriers to attendance at CR for type 2 MI compared to type 1 MI, and (3) undertake a pilot hybrid effectiveness-implementation clinical trial to assess if a multifaceted intervention increases attendance at CR and is potentially efficacious in improving health status for persons with type 2 MI as compared to usual care. For this latter aim, physicians will receive a reminder to consider referral to CR and patients will receive access to a patient engagement platform, with CR appointment reminders. Successful completion of the proposed studies will inform whether health status differs according to the subtype of MI and will explore if a multilevel intervention can increase CR attendance and potentially improve health status for those with type 2 MI. The objectives of this research award are to (1) develop an expertise in health status assessment and patient reported outcome measures, (2) learn how to design and interpret patient and clinician surveys, and 3) develop an expertise in clinical trial design, execution, and interpretation. Dr. McCarthy’s career goals are to undertake clinical trials that identify treatment approaches for individuals with type 2 MI. The findings from this proposal will form the foundation of Dr. McCarthy’s R01 application for a definitive effectiveness-implementation trial of CR for type 2 MI. Dr. McCarthy’s mentors and scientific advisors are experts in CR, qualitative and quantitative research, patient- reported outcome measures, and clinical trials. The combination of mentorship, formal coursework, and the proposed research studies will position Dr. McCarthy to become an independent NIH investigator while advancing knowledge on how to improve health status for persons with type 2 MI.

项目摘要 急性心肌梗死（MI）的特征是冠状动脉缺血导致的心肌坏死，并且可能是 由几种机制引起的。冠状动脉斑块破裂导致“1型心肌梗死”， 几十年来的研究和现在的几种疗法证明， 改善健康状况。然而，现在认识到至少有1/5的MI是“2型MI”，其发生是由于 由先前的生理应激引起的心肌氧供应/需求的不匹配。人 2型心肌梗死患者通常比1型心肌梗死患者年龄更大，合并症更多。但据 尚不清楚这些特征性差异是否会转化为健康状况的差异。2型MI是 与预后不良相关;只有40%的人在5年内存活。不幸的是，尽管 2型心肌梗死的发生率和预后，缺乏循证治疗策略， 临床试验基于运动的心脏康复（CR）对1型MI有效。然而，在这方面， CR几乎不用于2型MI。越来越多地采用CR（一种覆盖治疗）可能会改善以下患者的结局： 2型MI患者。本研究的目的是（1）确定患者是否存在差异- 2型与1型MI患者之间报告的健康状况，（2）从患者中获得关键信息 和临床医生对感知的好处，可接受性，证据要求，并出席CR的障碍 与1型MI相比，2型MI，以及（3）进行试点混合有效性-实施临床试验 评估多方面干预是否增加了CR的出勤率，并可能有效地改善 2型心肌梗死患者的健康状况与常规护理相比。对于后一个目标，医生将获得 提醒考虑转诊至CR，患者将获得患者参与平台的访问权限，CR 预约提醒成功完成拟议的研究将告知健康状况是否不同 根据MI的亚型，并将探讨多层次干预是否可以增加CR出勤率， 可能改善2型MI患者的健康状况。该研究奖的目标是（1） 发展健康状况评估和患者报告结果测量方面的专业知识，（2）学习如何 设计和解释患者和临床医生调查，以及3）发展临床试验设计，执行， 和解释。麦卡锡博士的职业目标是进行临床试验，确定治疗 2型心肌梗死患者的治疗方法。这项提案的发现将构成博士的基础。 McCarthy的R 01申请，用于CR治疗2型MI的确定性有效性实施试验。博士 麦卡锡的导师和科学顾问都是CR，定性和定量研究，病人- 报告的结果测量和临床试验。导师制、正式课程和 拟议的研究将使麦卡锡博士成为一名独立的NIH研究员， 提高关于如何改善2型心肌梗死患者健康状况的知识。