Identifying Disparities: Rural-Urban Comparison in Mechanical Circulatory Support

项目总结/文摘

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.