Improving cardiac rehabilitation outcomes using data from daily life: A novel, multi-method ambulatory assessment approach

项目总结/摘要 心脏康复（CR）是公认的有效和延长生命的治疗心血管疾病 心血管疾病（CVD），但许多患者并没有从治疗中受益。超过一半的病人谁开始， 最终退出。即使在坚持治疗的患者中，也有三分之一是“无应答者”， 对反应者和无反应者的人口统计学和生物学特征进行了调查， 无法确定可以解释原因的可靠差异。先前关于治疗依从性的研究， 由于依赖于方法学方法， 在医疗环境中进行的评估数量，这些评估对实际经验的普遍性有限 在正常的日常生活中大量研究表明，心血管事件和 社会心理困扰有着共同的流行病学，通过新出现的证据， 心理社会过程（例如，情绪调节，日常行为和社会交往）是预测的关键 心血管结局，本研究采用了一种新的评估方法，从 参与CR的患者在正常的日常生活中。N = 50例入组典型 12-一周的心脏康复计划将进行两周的日常生活评估（第一周 1和第二个在该计划的第12周）。评估将包括：1）生态瞬间 用于收集有关患者认知和情绪调节的主观数据的评估（EMA） 日常生活中的策略，2）使用电子激活记录器（EARTH）进行被动行为观察 评估患者的日常行为和社会交往，以及3）Actiwatch，用于被动评估 日常生活中的加速度、心率和心率变异性。由于使用了 被动评估方法。我们将使用先进的纵向，以人为本的建模方法 确定影响治疗依从性和CR应答的特定治疗可改变因素。我们 假设认知和情绪调节策略（目标1）、日常活动节奏和社交 相互作用（目标2）和连续评估的心血管生物标志物模式（目标3，探索性）将 每一个都预测治疗依从性和反应性结果。这项研究的创新之处在于它是第一个 研究整合这三个尖端的方法，是第一个应用“高分辨率”的日常 生活研究方法，以改善心血管疾病患者的治疗结果。结果将用作试点 数据，以告知专注于开发和测试精确医学的K或R应用程序， 进一步利用诸如移动的适应性干预等流动技术的干预， 通过本研究确定的日常生活治疗目标，患者对CR的反应性。

PROJECT SUMMARY / ABSTRACT Cardiac rehabilitation (CR) is widely recognized as an effective and life-prolonging treatment for cardiovascular disease (CVD), yet many patients do not benefit from treatment. More than half of patients who begin, ultimately dropout. Even among treatment adherent patients, one third are “non-responders”, and past investigations into the demographic and biological profiles of responders and non-responders have been unable to identify reliable differences that can explain why. Prior research on treatment adherence and responsiveness in CR has been limited by reliance on methodological approaches that only allow for a small number of assessments taken in medical environments that have limited generalizability to actual experiences during normal daily life. Building on the large body of research indicating that cardiovascular events and psychosocial distress share a common epidemiology, and by emerging evidence that transdiagnostic psychosocial processes (e.g., emotion regulation, daily behaviors and social interactions) are predictive of key cardiovascular outcomes, the present study employs a novel assessment approach to collect data from patients enrolled in CR as they go about their normal daily lives. N = 50 patients who are enrolling in a typical 12-week cardiac rehabilitation program will undergo two weeks of daily life assessments (the first during week 1 and the second during week 12 of the program). Assessments will include: 1) Ecological Momentary Assessment (EMA) for the collection of subjective data about patients’ cognitive and emotion regulation strategies in daily life, 2) behavioral observation using the Electronically Activated Recorder (EAR) for passive assessment of patients’ daily behaviors and social interactions, and 3) an Actiwatch, for passive assessment of accelerometry, heartrate and heartrate variability during daily life. Participant burden is minimal due to the use of passive assessment approaches. We will use advanced longitudinal, person-centered modeling approaches to identify specific, treatment-modifiable factors that affect treatment adherence and response to CR. We hypothesize that cognitive and emotion regulation strategies (Aim 1), daily activity pacing and social interactions (Aim 2), and patterns in continuously assessed cardiovascular biomarkers (Aim 3, Exploratory) will each predict treatment adherence and responsiveness outcomes. The study is innovative in that it is the first study to integrate these three cutting-edge methods, and is among the very first to apply “high resolution” daily life research approaches to improving treatment outcomes for patients with CVD. Results will be used as pilot data to inform a K or R application focused on developing and testing a precision-medicine informed intervention that further leverages ambulatory technologies such as mobile adaptive interventions to increase patient responsiveness to CR through daily life treatment targets identified through the present study.