Physiological and Psychological Stress in Left Ventricular Assist Device Patients

 描述(由申请人提供)：在美国，每年有100多万医院出院与心力衰竭有关。面临生命终结的晚期心力衰竭患者可能需要左心辅助装置(LVAD)。作为通往心脏移植的桥梁或作为不符合移植条件的人的目的地治疗，LVAD显著改善了生活质量和功能状态。然而，在植入设备后，人们注意到了情绪困扰和包括抑郁在内的心理后遗症。而且，虽然这种疗法确实比药物治疗延长了4倍的生命，但患有左冠状动脉左前降支的患者面临着植入后的多次住院、生活方式的适应和生命终结的考虑。适应这种设备的压力体验还没有被用来研究压力反应的生理和心理指标。这项拟议的研究将是第一次研究生理生物标记物和心理应激反应措施。通过横断面法，将测量对LVAD应激源的应力响应。本研究借鉴了非稳态负荷模型和Lazarus和Folkman的压力模型的概念框架。唾液皮质醇、C反应蛋白、感受到的压力和抑郁与生活质量、功能状态和住院率结果之间的关系 接受检查。统计分析将包括描述性统计和回归建模。除了建议的研究外，随附的培训计划将使申请者能够成为高级心力衰竭研究的独立科学家。申请者、她的赞助人和共同赞助人已经制定了一项培训计划，其中包括多个跨学科的心血管研究经验以及相关主题的额外课程和培训。这项拟议的研究将对压力和晚期心力衰竭的研究做出重大贡献，并与国家护理研究所的临终研究战略使命直接一致。

 DESCRIPTION (provided by applicant): In the United States, more than a million hospital discharges are heart failure-related each year. Advanced heart failure patients who face end-of-life may require a left ventricular assist device (LVAD). The LVAD, placed as a bridge to heart transplant or as destination therapy for those who do not qualify for transplant, significantly improves quality of life and functional status. However, emotional distress and psychological sequelae including depression have been noted following device insertion. And, though this therapy does extend life by as much as 4 times over medical management, individuals living with LVAD face multiple post-implant hospitalizations, lifestyle adaptations and end-of-life considerations. The stressful experience of adapting to this device has not been studied using physiological and psychological indicators of stress response. The proposed study will be the first to study physiologic biomarkers and psychological stress response measures. Through a cross-sectional approach, stress response to the LVAD stressor will be measured. This study is informed by a conceptual framework adapted from the Allostatic Load Model and Lazarus and Folkman's stress model. Relationships among salivary cortisol, C-reactive protein, perceived stress and depression and quality of life, functional status and hospitalization rate outcomes will be examined. Statistical analyses will include descriptive statistics and regression modeling. In addition to the proposed research, the accompanying training plan will enable the applicant to become an independent scientist in advanced heart failure research. The applicant, her sponsor, and co-sponsor have laid out a training plan, which includes multiple interdisciplinary cardiovascular research experiences as well as additional coursework and training in relevant topics. The proposed study will make a significant contribution to the study of stress and advanced heart failure and is in direct alignment with the end-of-life research strategic mission of the National Institute of Nursing Research.