Identifying Disparities: Rural-Urban Comparison in Mechanical Circulatory Support

项目摘要/摘要 在美国，心力衰竭(HF)仍然是影响成年人的最常见疾病之一 每年新增诊断85万例。治疗晚期心力衰竭最有益的疗法之一是 心脏移植；然而，潜在的移植接受者远远超过供体器官的供应，许多 患者没有资格进行移植。因此，已经制定了替代战略，以应对 晚期心衰的治疗包括持久的机械循环支持，也称为脑室 辅助装置(VAD)治疗。VAD通常只在较大的医疗机构中可用于植入 能够满足植入、常规设备护理和管理的复杂需求 紧急问题。虽然农村患者植入了该装置，但有足够的机会进行常规随访 护理和在医疗需要的时候是一个令人担忧的问题。然而，农村对临床VAD结果的影响以及 HRQOL尚不清楚。拟议研究的目的是确定农村和农村之间的结果差异。 城市VAD患者，长期目标是制定研究计划，以促进更好的结果 对于农村的退伍军人症人群。 拟议的研究将通过调查以下内容来确定农村VAD患者的结果差异 具体目标：1.)确定居住状态(城乡)与临床VAD的关系 植入装置后第一年的结果，其子目标是专门检查死亡、装置- 与住院人数和不良事件有关，以及2.)以确定居住状态的关系(农村 与城市相比)和患者报告的植入设备后第一年的HRQOL。的纵向数据 宾夕法尼亚州立好时医疗中心的VAD患者是机构间注册的一部分 机械辅助循环支持(INTERMACS)和俄勒冈健康与科学大学的数据 由Christopher Lee博士的R01《对高级机械支持的生物行为反应剖析》收集 将使用“心力衰竭”(5R01NR013492-04)。临床结果数据通常在1、3、6和 植入后12个月，出现不良事件和住院。拟议的研究还将 评估VAD患者居住状态(城乡)与患者报告的HRQOL的关系 从植入后3个月、6个月和12个月收集的数据。 研究结果将为针对农村VAD患者的博士后研究计划的发展提供信息 需要。博士后研究计划将涉及获得定性研究方面的高级技能， 将被用来深入了解患者在农村地区与VAD生活的经历。 最终，来自这两项研究的数据将被吸收，作为开发 农村VAD患者预后不良高危时期的干预护理对策。

Project Summary/Abstract Heart failure (HF) remains one of the most common diseases affecting adults in the United States with over 850,000 new diagnoses annually. One of the most beneficial therapies for treating advanced heart failure is heart transplantation; yet potential transplant recipients far exceed the supply of donor organs and many patients do not qualify for transplantation. Therefore, alternative strategies have been developed for the treatment of advanced HF including durable mechanical circulatory support also referred to as ventricular assist device (VAD) therapy. VADs are generally available for implantation only in larger healthcare institutions that are capable of meeting the complex demands of implantation, routine device care, and management of emergent problems. Although rural patients are implanted with the device, sufficient access to routine follow-up care and during times of medical need is a concern. Yet, the impact of rurality on clinical VAD outcomes and HRQoL is unknown. The purpose of the proposed study is to identify outcome disparities between rural and urban VAD patients with the long-term goal of developing a program of research to promote better outcomes for the rural VAD population. The proposed study will identify outcome disparities for rural VAD patients by investigating the following specific aims: 1.) To determine the relationship of residency status (rural versus urban) and clinical VAD outcomes in the first year following device implantation with sub-aims that specifically examine death, device- related hospital admissions and adverse events, and 2.)To determine the relationship of residency status (rural versus urban) and patient-reported HRQoL in the first year following device implantation. Longitudinal data of VAD patients from the Penn State Hershey Medical Center that are part of the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) and data from Oregon Health & Science University collected by Dr. Christopher Lee's R01 “Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure” (5R01NR013492-04) will be utilized. Clinical outcome data are collected routinely at 1, 3, 6 and 12 months post-implantation and with adverse events and hospitalizations. The proposed study will also evaluate the relationship of residency status (rural versus urban) to patient-reported HRQoL in VAD patients from data collected at 3, 6 and 12 months post-implantation. Study findings will inform the development of a post-doctoral program of research aimed at rural VAD patient needs. The post-doctoral research plan will involve acquisition of advanced skills in qualitative research that will be utilized to gain in-depth knowledge of the patient's experience of living with a VAD in a rural area. Ultimately, data from both studies will be assimilated to serve as a platform for the development of interventional nursing strategies during the periods of highest risk for poor outcomes in rural VAD patients.