The Influence of Heart Failure Self-Care Behavior on Cardiac Performance

简介(申请人提供)：心力衰竭(HF)是一种影响500多万美国人的综合征，与残疾、发病率增加和生活质量下降有关。自我护理可能是控制液体滞留和内分泌反应的一种方法，这种方法会损害心功能，导致患者预后不佳。尽管自我护理被假设会影响心脏功能，但这一说法的科学基础尚未建立。我们需要进一步的证据表明，心衰患者的日常自我护理实践可以影响心脏功能，以便给患者留下深刻印象，让他们知道他们在维持最佳心脏性能和提高他们的健康质量和健康年限方面所发挥的重要作用。我们打算使用生物阻抗心动图技术和激素测量，以及一种战略性的俯仰倾斜程序，以被动和非侵入性地挑战心脏的性能，以深入了解这种关系。我们建议进行一项横断面研究，以检验使用主观和客观测量方法测量的心衰自我护理与15分钟头低位挑战时客观测量的心功能之间的关系。这项研究的具体目的是：1)通过测量A)心力衰竭自理指数、医学结果研究特殊依从量表和24小时尿钠水平以评估是否坚持低钠饮食，以及B)心功能以心钠素水平作为心房扩张的指标，以及使用生物阻抗心动图(包括胸液容量指数、每搏输出量指数和加速指数)来描述心力衰竭自我护理和基础心功能之间的关系，以及2)描述心力衰竭自我护理与15分钟后动态心功能的关系，15？头朝下倾斜姿势挑战。心衰自我护理的测量将与心脏性能测量对身体位置的响应的相对变化进行比较。这项研究考察了心力衰竭患者的自我护理行为，以及他们在休息和压力下的心脏功能。这项研究将有助于确定心力衰竭患者的日常自我护理行为是否会影响心脏的功能。

DESCRIPTION (provided by applicant): Heart failure (HF), a syndrome that affects more than five million Americans, is associated with disability, increased morbidity, and decreased quality-of-life. Self-care may be one way of controlling fluid retention and endocrine responses to HF that impair cardiac performance and lead to poor patient outcomes. Although self-care is hypothesized to influence cardiac performance, the scientific basis of this claim has not yet been established. We need further evidence that HF patient's day-to-day self-care practices can influence cardiac performance in order to impress on patients the important role that they play in maintaining optimal cardiac performance and in increasing the quality and years of their health. We intend to use bioimpedance cardiography technology and hormone measurement, along with a strategic procedure of head-down tilt to passively and non-invasively challenge the heart's performance to gain insight into this relationship. A cross-sectional study is proposed to examine the relationship between HF self-care measured using subjective and objective measures and the objective measurement of cardiac performance in response to fifteen minutes of a 15¿ head-down tilt positional challenge. The specific aims of this study are to: 1) describe the relationship between HF self-care and baseline cardiac performance, by measuring A) self-care with the Self-Care of Heart Failure Index, the Medical Outcomes Study Specific Adherence Scale, and 24-hour urine sodium levels to assess adherence to a low sodium diet, and B) cardiac performance with blood levels of atrial natriuretic peptide, as an index of atrial distension, and cardiac hemodynamics with bioimpedence cardiography, including thoracic fluid volume index, stroke volume index, and acceleration index, and 2) describe the relationship between HF self-care and dynamic cardiac performance in response to a fifteen minute, 15¿ head-down tilt positional challenge. Measures of HF self-care will be compared to the relative change in measures of cardiac performance in response to body positioning. This research study examines the self-care behaviors of persons with heart failure and how their heart functions at rest and when stressed. This study will help determine if the day-to-day self-care behaviors of heart failure patients can influence how the heart functions.