Gender Differences in Physical Activity Among Patients with Implantable Cardioverter Defibrillators (ICDs)

项目摘要/摘要 这一职业发展奖将促进罗斯曼博士向独立研究生涯的过渡，并 支持她成为未来女性心血管健康领域的领导者。它会让她获得知识， 开发以患者为中心的干预措施以改善心血管疾病和质量所需的工具和经验 对患有心律失常和植入性心律转复除颤器(ICD)的妇女的生活结局的影响。这些 长期目标得到了一项为期5年的培训计划的支持，该计划旨在发展以下方面的专门知识：(1)慢性病 流行病学和生物统计学；(2)体力活动(PA)评估和数据分析；(3)临床试验； (4)以技术为基础的干预(MHealth)。她已经组建了一个由多学科导师组成的团队，这些导师 流行病学、生物统计学、PA、心脏电生理学和基于技术的(MHealth)临床方面的专家 在丰富的研究环境中帮助她过渡到独立的试验。罗斯曼医生是一名临床医生 心理学家，耶鲁大学心血管行为医学博士后研究员 医学。这项建议建立在她的临床背景和先前的研究基础上，这些研究的重点是 女性心脑血管疾病患者的功能状态和生活质量 心律不齐。 在过去的6年里，罗斯曼博士的大部分临床工作和研究都集中在 患有ICD的心律失常患者，由于缺乏运动而死亡风险增加。女性也在其中 最不活跃的ICD患者，不良结局风险增加，但参与传统PA 干预措施(例如，心脏康复)仍然很少。移动健康可能会提供创新和经济高效的 与患有ICD的妇女接触的方法，收集详细的行为数据(例如，从内置的ICD加速度计)， 并将这些数据与患者报告的结果相结合，以实时提供有针对性的反馈并促进 行为改变。然而，为ICD患者建立这些干预措施并为其量身定做的知识基础 对于女性来说(例如，ICD植入后PA的模式、预测因素和障碍的性别差异)是缺乏的。 此外，还缺乏关于PA水平与较低的死亡风险、性别有关的必要数据 这些结果的差异以及对PA干预的偏好(S)。罗斯曼博士的研究计划将 使用纵向ICD加速度计和EMR数据解决知识中的这些关键差距， 预期登记的ICD患者的全国样本。她将：目标1：检查PA和PA的性别差异 ICD植入后不活动的危险因素；以及目的2：检验PA与这些患者死亡率之间的关系 病人。在目标3：她将对新植入的ICD患者进行调查，以确定性别差异 PA的特征、目标、障碍和PA干预的偏好。移动健康的可接受性 还将对技术进行评估。拟议的研究将提供证据基础，以支持我的下一步 职业目标是开发和测试以患者为中心的干预措施，以增加ICD女性患者的PA。

PROJECT SUMMARY/ABSTRACT This career development award will facilitate Dr. Rosman’s transition to an independent research career and support her becoming a future leader in women’s cardiovascular health. It will equip her with the knowledge, tools, and experiences needed to develop patient-centered interventions to improve cardiovascular and quality of life outcomes in women with cardiac arrhythmias and implantable cardioverter-defibrillators (ICDs). These long-term goals are supported by a 5-year training plan to develop expertise in: (1) chronic disease epidemiology and biostatistics; (2) physical activity (PA) assessment and data analysis; (3) clinical trials; and (4) technology-based interventions (mHealth). She has assembled a multidisciplinary team of mentors who are experts in epidemiology, biostatistics, PA, cardiac electrophysiology, and technology-based (mHealth) clinical trials to facilitate her transition to independence in a rich research environment. Dr. Rosman is a Clinical Health Psychologist and a postdoctoral research fellow in Cardiovascular Behavioral Medicine at the Yale School of Medicine. This proposal builds logically on her clinical background and prior research, which has focused on functional status and quality of life outcomes in women with cardiovascular disease and patients with arrhythmias. For the past 6 years, much of Dr. Rosman’s clinical work and research has focused on a subset of arrhythmia patients with ICDs who have an elevated mortality risk due to physical inactivity. Women are among the least active ICD patients and have an elevated risk for adverse outcomes, yet participation in traditional PA interventions (e.g., cardiac rehabilitation) remains low. mHealth may offer an innovative and cost-effective method to engage women with ICDs, collect detailed behavioral data (e.g., from built-in ICD accelerometer), and integrate these data with patient-reported outcomes to provide targeted feedback in real-time and promote behavior change. Yet the knowledge base upon which to build these interventions for ICD patients and tailor it for women (e.g., gender differences in the patterns, predictors, and barriers to PA after ICD implant) is lacking. Also lacking is the requisite data concerning levels of PA associated with lower mortality risk, gender differences in these outcomes, and preferences for PA intervention(s). Dr. Rosman’s research plan will address these critical gaps in knowledge using longitudinal ICD-accelerometer and EMR data from a large, national sample of prospectively enrolled ICD patients. She will: AIM 1: examine gender differences in PA and risk factors for inactivity after ICD implant; and AIM 2: examine associations between PA and mortality in these patients. In AIM 3: she will conduct a survey of newly implanted ICD patients to identify gender differences in PA characteristics, goals, barriers, and preferences for PA intervention. The acceptability of mHealth technology will also be assessed. The proposed research will provide an evidence base to support my next career goal of developing and testing a patient-centered intervention to increase PA in women with ICDs.