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

项目总结 心力衰竭(HF)是美国老龄化人口面临的毁灭性公共健康问题。这是导致 老年人的住院和老年患者的心衰住院负担要大得多。 随后的临床事件(再住院和死亡)的风险比年轻患者的风险更大。心衰住院 也与家庭照顾者，特别是配偶/伴侣的关注结果有关，他们经历了 在他们所爱的人住院后，照顾者的压力(即负担)程度更高，死亡风险更高。 鉴于症状恶化是心力衰竭住院的主要原因，及时的症状反应是 对于维持临床稳定性至关重要，研究的一个主要焦点一直是通过针对性地减少心衰再入院 心衰患者症状监测及反应。然而，已经进行了多项大型心力衰竭症状监测试验 出院后在改善患者预后方面不一致的成功。此外，这些研究很少包括 家庭照顾者，尽管照顾者在控制症状方面发挥着主要作用，但他们自己 经历与患者住院相关的不良健康结局。这项提议的总体科学目标是 通过检查患者和他们的护理伙伴如何监控症状来解决这一关键的知识差距 一起检验总体假设，即评估症状相似的患者和照顾者，以及 谁的评估准确地反映了临床稳定性的变化，就会有更好的症状反应和更好的 个人的和二元的结果。我们将招募50名因心力衰竭住院的老年人及其护理人员 配偶/伴侣每天对心力衰竭进展的症状和临床生物标志物进行日记研究，并遵循这些研究 在高危出院后时期(5周)。利用密集的方法对二元数进行建模 动态，我们将：(1)描述患者和护理人员对患者心力衰竭症状的评估的一致性 在出院后期间；(2)确定患者和照顾者的心衰症状是否一致 评估可预测患者的事件风险、照顾者的压力、二元症状反应和健康状况；以及 (3)描述患者和照顾者的症状评估如何与心力衰竭的临床生物标记物相关。 充血，以及三角症状评估与临床生物标记物是否识别高风险二元 症状监测的模式。这项拟议的研究将在资源丰富的环境中进行， 包括由美国国立卫生研究院资助的临床和转化科学中心以及许多其他机构和导师 在老年夫妇中进行心力衰竭研究的资源。这项研究的执行，加上一项 全面的培训计划(正式课程、研讨会、实践和沉浸体验、一对一 培训)，支持该奖项的职业发展目标，即为应聘者提供技能 必要的(密集的二元纵向设计和分析，临床生物标记物的整合)以过渡到 科学独立和促进她制定可持续的、创新的计划的长期目标 研究改善患者和照顾者的健康，因为他们一起管理心力衰竭。

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.