The Symmetry-HF Study: Symptom Dynamics and Clinical Biomarkers of Heart Failure in Older Adult Care Dyads After Heart Failure Hospitalization

项目摘要 心力衰竭（HF）是美国老龄化人口的一个毁灭性的公共卫生问题。这是主要原因， 老年人的住院和老年患者的HF住院负担更高 随后的临床事件（再住院和死亡）的发生率高于年轻患者。HF住院治疗 也与家庭照顾者的结果有关，特别是配偶/伴侣， 在他们所爱的人住院后，照顾者的压力（即负担）和死亡风险更高。 鉴于症状恶化是HF住院的主要驱动因素，及时的症状缓解是 对于维持临床稳定性至关重要，研究的一个主要焦点是通过靶向治疗减少HF再入院， HF患者症状监测和响应。然而，多个大型HF症状监测试验已经被证实， 在改善患者出院后结局方面的成功率不一致。此外，这些研究很少包括 家庭照顾者，尽管事实上，照顾者在管理症状中发挥着重要作用，他们自己 经历与患者住院相关的不良健康结果。该提案的总体科学目标是 通过检查患者及其伴侣如何监测症状来解决这一关键的知识缺口 一起，并测试整体假设，即患者和护理人员谁评估症状相似， 其评估准确地反映了临床稳定性的变化，将具有更好的症状反应和更好的 个体和二元结果。我们将招募50名因HF住院的老年人， 配偶/伴侣进行HF进展的症状和临床生物标志物的每日日记研究，并对其进行随访 在高风险出院后期间（5周）。利用密集型方法进行二元建模 动力学，我们将：（1）表征患者和护理人员对患者HF症状评估的一致性 在出院后期间;（2）确定患者和护理人员HF症状是否一致 评估可预测患者事件风险、护理人员压力以及二元症状反应和健康状况;以及 (3)描述患者和护理人员症状评估如何与HF的临床生物标志物相关地变化 充血，以及用临床生物标志物进行症状评估是否能识别高风险的二元 症状监测模式。这项拟议的研究将在资源丰富的环境中进行， 包括NIH资助的临床和转化科学中心以及许多其他机构和导师 在老年夫妇中进行HF研究的资源。这项研究的执行，加上一个 全面的培训计划（正式课程、研讨会、实践和沉浸式体验、一对一 培训），支持该奖项的职业发展目标，即为候选人提供技能 必要的（密集的二元纵向设计和分析，临床生物标志物的整合），以过渡到 科学的独立性，并促进她的长期目标，发展可持续的，创新的计划， 研究，以改善患者和护理人员的健康，因为他们一起管理HF。

PROJECT SUMMARY Heart failure (HF) is a devastating public health issue for America's aging population. It is the primary reason for hospital admission for older adults, and HF hospitalization for older adult patients carries a much higher burden of subsequent clinical events (rehospitalization and death) than it holds for younger patients. HF hospitalization is also associated with concerning outcomes for family caregivers, particularly spouses/partners, who experience higher degrees of caregiver strain (i.e. burden) and higher mortality risk after their loved one is hospitalized. Given that worsening symptoms are the primary driver of HF hospitalizations, and timely symptom response is critical for maintaining clinical stability, a major focus of research has been reducing HF readmissions by targeting HF patient symptom monitoring and response. However, multiple large HF symptom monitoring trials have been inconsistently successful in improving patient outcomes post-discharge. Moreover, these studies rarely include family caregivers, despite the fact that caregivers play a major role in managing symptoms, and they themselves experience poor health outcomes related to patient hospitalization. The overall scientific goal of this proposal is to address this critical knowledge gap by examining how patients and their caregiving partners monitor symptoms together, and testing the overall hypothesis that patients and caregivers who assess symptoms similarly, and whose assessments accurately reflect changes in clinical stability, will have better symptom response and better individual and dyadic outcomes. We will enroll 50 older adults hospitalized for HF and their caregiving spouse/partner for a daily diary study of symptoms and clinical biomarkers of HF progression, and follow them during the high risk post-discharge period (5 weeks). Leveraging intensive approaches for modeling dyadic dynamics, we will: (1) Characterize agreement in patient and caregiver assessments of patient HF symptoms during the post-discharge period; (2) Determine whether agreement in patient and caregiver HF symptom assessments predicts patient event-risk, caregiver strain, and dyadic symptom response and health status; and (3) Describe how patient and caregiver symptom assessments change in relation to clinical biomarkers of HF congestion, and whether triangulating symptom assessments with clinical biomarkers identifies high risk dyadic patterns of symptom monitoring. This proposed research will be conducted in a resource-rich environment, which includes an NIH-funded Clinical and Translational Science Center and numerous other institutional and mentor resources for conducting HF research in older adult couples. The execution of this study, coupled with a comprehensive training plan (formal coursework, workshops, hands-on and immersion experiences, one-on-one training), supports the career development goal of this award, which is to provide the Candidate with the skills necessary (intensive dyadic longitudinal designs and analysis, integration of clinical biomarkers) to transition to scientific independence and facilitate her long-term goal of developing a sustainable, innovative program of research to improve the health of patients and caregivers as they manage HF together.