Physiological and Psychological Stress in Left Ventricular Assist Device Patients

左心室辅助装置患者的生理和心理压力

• 批准号: 9110722
• 负责人: Martha Allison Abshire
• 金额: $ 3.83万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-04-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9110722
• 关键词: Abdomen; Adjustment Disorders; Affect; Age; Area; Automobile Driving; Bathing; Biological Markers; Body Image; C-reactive protein; Cardiovascular system; Caregivers; Caring; Characteristics; Cicatrix; Complex; Cross-Sectional Studies; Data; Destinations; Development; Devices; Event; Face; Heart; Heart Transplantation; Heart failure; Hospitalization; Hospitals; Hydrocortisone; Hypertension; Implant; Individual; Intervention; Left; Life; Life Style; Measures; Mediator of activation protein; Medical; Mental Depression; Mission; Modeling; Myocardial Infarction; National Institute of Nursing Research; Outcome; Patients; Physiological; Population; Psychological Stress; Pump; Qualifying; Qualitative Research; Quality of life; Repeat Surgery; Research; Risk; Salivary; Scientist; Self-Help Devices; Social support; Staging; Stress; Swimming; Technology; Testing; Time; Training; Transplant Recipients; Transplantation; United States; Ventricular; allostatic load; biological adaptation to stress; cardiovascular health; coping; disability; emotional distress; end of life; experience; functional status; health care service utilization; high risk; implantation; improved; improved outcome; left ventricular assist device; mortality; palliative; psychologic; public health relevance; response; statistics; stressor

 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.

 描述（由适用提供）：在美国，每年有超过一百万的医院出院与心力衰竭有关。面对寿命的晚期心力衰竭患者可能需要左心室辅助装置（LVAD）。 LVAD作为通往心脏移植的桥梁或不参加移植资格的人的目的地治疗，可显着提高生活质量和功能状况。但是，在插入设备后，已经注意到情绪困扰和心理后遗症，包括抑郁症。而且，尽管这种疗法的生命确实超过了医疗管理的4倍，但患有LVAD的人面临多次植入后住院，生活方式的适应和寿命末考虑。使用压力反应的身体和心理指标，尚未研究适应该设备的压力经验。拟议的研究将是第一个研究生理生物标志物和心理压力反应度量的研究。通过横截面方法，将测量对LVAD应激源的应力反应。这项研究是由一个由Allostatic Load模型和Lazarus和Folkman的压力模型改编的概念框架所告知的。唾液皮质醇，C反应蛋白，感知压力和抑郁以及生活质量，功能状况和住院率的关系将 被检查。统计分析将包括描述性统计和回归建模。除了拟议的研究外，参与的培训计划还将使该应用程序成为高级心力衰竭研究的独立科学家。该应用程序，她的赞助商和共同赞助商制定了培训计划，其中包括多个跨学科的心血管研究经验以及相关主题的其他课程和培训。拟议的研究将为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保持一致。