Profiling the Heterogeneous Response of Exercise therapy in HF patients

描述（由申请人提供）：这项个人国家研究服务奖（NRSA）申请的目的是为护士提供研究培训，使其成为一名独立的研究者，重点关注心力衰竭（HF）患者人群中的运动疗法（定义为持续至少8周的常规运动）如何影响生理和症状变化的平行过程并影响HF患者的结局。除了支持学术课程，获得方法和统计技能，并学习进行道德健全的研究与弱势群体，这个NRSA培训补助金还将支持研究，以解释运动疗法在HF患者人群的异质性反应。从临床角度来看，运动疗法有巨大的潜力可以更好地融入患者护理计划，并由医疗保险报销。首先需要进一步了解谁受益最大。 我假设HF患者人群对运动疗法有共同和不同的反应，这些反应可以被识别、预测和量化，并与健康结果相关。我将使用来自心力衰竭和运动训练结果对照试验（HF-ACTION）数据集的患者亚组来实证研究这一假设。我已获得特别许可使用该数据集，包括本研究主要研究者Christopher奥康纳博士和大卫惠兰博士提供的生物标志物、症状和结局数据。我的研究培训将由我的申办者和共同申办者指导，他们是两位国际知名的HF科学家，著名的HF护士专家和领导者Barbara里格尔博士和备受赞誉的HF移植专家Kenneth Margulies博士。该项目还将获得克里斯托弗·李博士的重要投入， 护理科学家，高级方法学家和该项目的顾问。 这项研究培训的长期影响是重要的，因为运动训练是一种自我管理行为，强烈鼓励但在HF患者人群中使用不足。这项研究与国家护理研究所的优先事项密切相关，这些优先事项规定需要调查健康的多种决定因素以及它们对患者自我管理疾病、管理症状和改善与健康有关的生活质量的能力的影响。这项工作将导致谁的目标与具体的定制运动干预知识。本申请中提出的具体研究和方法学方法对许多利益相关者具有广泛的适用性，包括专业人员、护理人员和HF患者。 公共卫生相关性：我的博士前培训的重点是成为一名独立的护士调查员。该奖学金的研究部分侧重于使用生长混合模型表征HF患者对运动治疗的异质性生理和症状反应。虽然运动疗法在HF患者人群中是安全的，但由于运动生物学机制尚未得到很好的表征或理解，因此并未常规纳入患者的治疗计划。尽管许多临床医生主张转诊至心脏康复中心，但医疗保险并不报销。拟议的研究将剖析运动疗法的异质性反应（通过不同轨迹来表征它们），并确定表现出良好反应的HF患者的选择亚群。长期的意义是能够提供科学证据来支持对HF患者的医疗保险报销，这些患者将从运动治疗中受益最多。

DESCRIPTION (provided by applicant): The purpose of this individual National Research Service Award (NRSA) application is to provide research training for a nurse to become an independent investigator focusing on how exercise therapy, defined as routine exercise lasting at least 8 weeks, in the heart failure (HF) patient population impacts the parallel processes of physiologic and symptom changes and influences HF patients' outcomes. In addition to supporting scholarly coursework, acquiring methodological and statistical skills, and learning to conduct ethically sound research with vulnerable populations, this NRSA training grant will also support research to explain the heterogeneous response to exercise therapy in the HF patient population. From a clinical perspective, there is huge potential for exercise therapy to be better integrated into patient care plans and be reimbursed by Medicare. Further understanding of who benefits most is first needed. I hypothesize that there are common and distinct responses to exercise therapy in the HF patient population that can be identified, predicted, and quantified in association with health outcomes. I will investigate this hypothesis empirically using a subgroup of patients from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) dataset. I have received special permission to use the dataset, including biomarker, symptom and outcome data from the principal investigators of the study: Dr. Christopher O'Connor and Dr. David Whellan. My research training will be guided by my sponsor and co- sponsor who are two internationally known HF scientists, Dr. Barbara Riegel, a well-known HF nurse expert and leader, and Dr. Kenneth Margulies, a highly acclaimed HF transplant specialist. This project will also receive significant input from Dr. Christopher Lee, a nurse scientist, advanced methodologist and consultant on this project. The long-term impact of this research training is important because exercise training is a self-management behavior strongly encouraged but under-used in the HF patient population. This research is closely assigned with the priorities of the National Institute of Nursing Research, which specify the need to investigate multiple determinants of health and the impact they have on patients' ability to self-manage their disease, manage their symptoms and improve their health-related quality of life. This work will lead to knowledge of whom to target with specific tailored exercise interventions. The specific research and methodological approach proposed in this application has wide applicability to many stakeholders, including professionals, caregivers and patients with HF. PUBLIC HEALTH RELEVANCE: The focus of my pre-doctoral training is on becoming an independent nurse investigator. The research component of this fellowship focuses on characterizing the heterogeneous physiologic and symptom responses to exercise therapy in HF patients using growth mixture modeling. Although exercise therapy is known to be safe in the HF patient population, it is not routinely incorporated into patients' treatment plans because the symptom-biology mechanisms are not well characterized or understood. Although many clinicians advocate referral to Cardiac Rehabilitation, Medicare does not reimburse it. The proposed research will dissect the heterogeneous responses to exercise therapy (by characterizing them in terms of distinct trajectories) and identify select subpopulations of HF patients who demonstrate favorable responses. The longer-term implication is to be able to provide the scientific evidence to support advocating for Medicare reimbursement for HF patients who will benefit most from exercise therapy.