Identifying Disparities: Rural-Urban Comparison in Mechanical Circulatory Support

项目总结/摘要 心力衰竭（HF）仍然是影响美国成年人的最常见疾病之一， 每年新增85万例诊断。治疗晚期心力衰竭最有效的疗法之一是 心脏移植;然而，潜在的移植受体远远超过捐赠器官的供应，许多 患者不符合移植条件。因此，已经开发了替代策略， 晚期HF的治疗，包括持久的机械循环支持，也称为心室 辅助装置（VAD）治疗。VAD通常仅在较大的医疗机构中可用于植入 能够满足植入、常规器械护理和 紧急问题。尽管农村患者植入了该装置，但常规随访的充足途径 护理和医疗需要期间是一个问题。然而，农村对临床VAD结局的影响， HRQoL未知。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患者的长期目标是制定一项研究计划，以促进更好的结果 对于农村的VAD人群来说。 拟议的研究将通过调查以下内容来确定农村VAD患者的结局差异 具体目标：1.）确定居住状态（农村与城市）与临床VAD的关系 器械植入后第一年的结局，子目标专门检查死亡、器械- 相关住院和不良事件，以及2.）确定居住身份关系（农村 与城市相比）和患者报告的HRQoL。纵向数据 来自宾夕法尼亚州好时医疗中心的VAD患者是跨机构登记的一部分， 机械辅助循环支持（INTERMACS）和来自俄勒冈州健康与科学大学的数据 由Christopher Lee博士的R 01“分析生物行为对高级机械支持的反应”收集 将使用“心力衰竭”（5 R 01 NR 013492 -04）。在第1、3、6和7天常规收集临床结局数据。 植入后12个月，发生不良事件和住院。拟议的研究还将 评价VAD患者的居住状态（农村与城市）与患者报告的HRQoL的关系 来自植入后3、6和12个月收集的数据。 研究结果将为针对农村VAD患者的博士后研究项目的发展提供信息 需求博士后研究计划将涉及获得定性研究的高级技能， 将用于深入了解患者在农村地区患有VAD的经历。 最终，这两项研究的数据将被吸收，作为开发 农村VAD患者预后不良高危期的干预护理策略。

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.