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

项目总结/摘要 这个职业发展奖将促进博士罗斯曼的过渡到一个独立的研究生涯， 支持她成为未来女性心血管健康的领导者。它会让她知道， 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 心律失常和植入式心脏复律器（ICD）女性患者的生活结局。这些 长期目标由一个5年培训计划支持，以发展以下方面的专业知识：（1）慢性疾病 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;以及 (4)基于技术的干预措施（mHealth）。她组建了一个多学科的导师团队， 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 试验，以促进她过渡到独立的丰富的研究环境。Rosman博士是一名临床健康 心理学家，耶鲁大学心血管行为医学博士后研究员， 药这一建议逻辑上建立在她的临床背景和先前的研究，重点是 女性心血管疾病患者和 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一个子集， 由于缺乏体力活动导致死亡风险升高的植入ICD的心律失常患者。妇女属于 ICD患者活动最少，不良结局风险升高，但参与传统PA 干预（例如，心脏康复）仍然很低。移动健康可以提供一个创新的和具有成本效益的 使使用ICD的女性参与的方法，收集详细的行为数据（例如，从内置ICD加速计）， 并将这些数据与患者报告的结果相结合，以提供实时的有针对性的反馈， 行为改变然而，为ICD患者建立这些干预措施并对其进行调整的知识基础 对于女性（例如，ICD植入后PA模式、预测因素和障碍的性别差异）。 同样缺乏的是关于PA水平与较低死亡率风险、性别和年龄相关的必要数据。 这些结果的差异以及对PA干预的偏好。罗斯曼博士的研究计划 利用纵向ICD-加速度计和EMR数据解决这些关键的知识差距， 前瞻性入组ICD患者的国家样本。她将：目标1：检查PA中的性别差异， ICD植入后不活动的风险因素;以及AIM 2：检查这些患者中PA与死亡率之间的相关性。 患者在AIM 3中：她将对新植入ICD的患者进行调查，以确定 PA特征、目标、障碍和PA干预的偏好。移动健康的可接受性 还将评估技术。拟议的研究将提供一个证据基础，以支持我的下一个 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.