Physiological and Psychological Stress in Left Ventricular Assist Device Patients

 描述（由申请人提供）：在美国，每年有超过一百万的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室辅助装置（LVAD）。LVAD作为心脏移植的桥梁或不符合移植条件的患者的目的地治疗，可显著改善生活质量和功能状态。然而，在器械插入后，注意到情绪困扰和心理后遗症，包括抑郁症。而且，尽管这种治疗确实延长了医疗管理的4倍，但LVAD患者面临多种植入后住院治疗，生活方式适应和生命终了考虑。尚未使用压力反应的生理和心理指标来研究适应这种设备的压力体验。这项拟议中的研究将是第一个研究生理生物标志物和心理应激反应措施的研究。通过横截面方法，将测量对LVAD应激源的应激反应。这项研究是由一个概念框架改编自非稳态负荷模型和Lazarus和Folkman的压力模型。唾液皮质醇、C-反应蛋白、感知压力和抑郁与生活质量、功能状态和住院率结局之间的关系将 接受检查。统计分析将包括描述性统计和回归建模。除了拟议的研究，伴随的培训计划将使申请人成为先进的心力衰竭研究的独立科学家。申请人，她的赞助商和共同赞助商已经制定了培训计划，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。拟议的研究将作出重大贡献的压力和先进的心力衰竭的研究，是在直接对齐与临终研究战略使命的国家护理研究所。

 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.