Heart Failure Disparities in Native Hawaiians

描述(由申请人提供)： 心力衰竭(HF)是一个主要的公共卫生问题，导致相当大的心血管发病率和死亡率。HF对土著夏威夷人(NHS)和其他太平洋人(PPS)等少数群体的影响尚不清楚。众所周知，NHS有很高的心力衰竭风险因素，这是美国心血管疾病(CVD)死亡率最高的疾病之一。众所周知，获得适当的护理可以改善心力衰竭患者的健康状况，但获得专科护理是NHS和PPS的主要障碍，因为他们往往居住在医疗服务不足的地区。为了解决NHS和PPS之间的心力衰竭差异，将在爱玛女王诊所(QEC)和NH卫生部之间建立一个伙伴关系计划，即心力衰竭差异计划(HFD)。HFD计划的合作伙伴包括：MedStar研究所、瓦胡岛社区卫生中心(CHCs)和夏威夷出口中心，后者是美国国立卫生研究院资助的一项倡议，旨在解决NH/PP中与糖尿病相关的差异。HFD计划将实现以下研究和教育目标：1)确定社区卫生工作者与受过专业培训的超声诊断师相比所做超声心动图的可靠性和有效性，并将其作为“黄金标准”。2)确定与常规护理相比，具有文化素质的心力衰竭教育项目是否能减少心力衰竭的住院和死亡率。3)比较NHS和PPS住院患者心力衰竭综合征与白人心力衰竭综合征的种族差异。4)使用QEC确定的先证者构建HF家系，以便将来在NHS和PPS中进行HF连锁研究。5)教育社区卫生工作者在NHS和PPS高危人群中进行超声心动图扫描，以检测心力衰竭。6)培训新的研究人员，以开展侧重于一般心血管疾病差异，特别是心力衰竭的研究。通过实现这些目标，HFD计划将改善为NHS和PPS服务的CHCs获得心力衰竭护理的机会，填补NHS和PPS中心血管疾病差异的知识空白，并为未来对Hf的遗传决定因素的研究提供基础。

DESCRIPTION (provided by applicant): Heart failure (HF) is a major public health problem leading to considerable cardiovascular morbidity & mortality. The impact of HF on minority populations, such as Native Hawaiians (NHs) & other Pacific Peoples (PPs), is unknown. NHs are known to have high rates of risk factors for HF & one of the highest rates of cardiovascular disease (CVD) mortality in the U.S. Access to appropriate care is known to improve health outcomes for HF patients, but access to specialist care presents a major barrier for NHs & PPs because they tend to reside in medically underserved areas. To address HF disparities among NHs and PPs, a partnership program, the HF Disparities Program (HFD), will be established between the Queen Emma Clinic (QEC) and the Department of NH Health. Partners of the HFD Program include: MedStar Research Institute, Oahu-based Community Health Centers (CHCs) & the Hawaii EXPORT Center, an NIH-funded initiative addressing diabetes-associated disparities in NH/PP. The HFD Program will achieve the following research & educational aims: 1) Determine the reliability & validity of echocardiograms performed by community-based health workers compared to a professionally trained sonographer as the "gold standard". 2) Determine if a culturally competent educational program for heart failure reduces HF hospitalizations & mortality compared to usual care. 3) Characterize ethnic differences in the heart failure syndrome in hospitalized NHs & PPs compared to Caucasians. 4) Construct HF pedigrees using probands identified at the QEC for a future HF linkage study in NHs & PPs. 5) Educate community-based health workers to perform echocardiography scans for the detection of HF in a high risk population of NHs & PPs. 6) Train new investigators to conduct research focused on CVD disparities in general, and heart failure in particular. By achieving these aims, the HFD Program will improve access to HF care at CHCs that serve NHs & PPs, fill a gap in knowledge of CVD disparities in NHs & PPs and provide a foundation for future studies on genetic determinants of HF.