Improving the Health Status of Individuals with Type 2 Myocardial Infarction

项目摘要 急性心肌梗死(MI)的特征是由于冠状动脉缺血而导致的心肌坏死，可能是 由几种机制沉淀而成。冠状动脉斑块破裂导致“1型心肌梗死”，这是一个激烈的主题 几十年的研究，现在有几种治疗方法被证明可以降低死亡率和 改善健康状况。然而，现在人们认识到，至少每5个失败率中就有1个是由于以下原因而发生的 导致由先前生理应激引起的心肌供氧/需氧不匹配。人 与1型心肌梗死患者相比，2型心肌梗死患者通常年龄较大，并有更多的并发症。然而，它是 尚不清楚这些特征差异是否会转化为健康状况的差异。类型2 MI是 预后不佳；只有40%的人在5年后还活着。不幸的是，尽管 2型心肌梗死的发生率和预后，由于缺乏循证治疗策略 临床试验。以运动为基础的心脏康复(CR)对1型心肌梗死是明显有效的。然而， 对于类型2的MI，实际上未使用CR。增加对CR的采用，这是一种覆盖疗法，可能会改善 2型心肌梗塞患者。这项研究计划的目的是(1)确定患者是否存在差异- 报告2型心肌梗死与1型心肌梗死患者之间的健康状况，(2)从患者那里获得关键信息 和临床医生对CR就诊的感知益处、可接受性、证据要求和障碍 对2型心肌梗死与1型心肌梗死进行比较，以及(3)进行试点混合有效性-实施临床试验 评估多方面的干预是否增加了CR的出勤率，并可能有效地改善 与常规护理相比，2型心肌梗死患者的健康状况。对于后一个目标，医生将获得 提醒考虑转诊到CR，患者将获得访问具有CR的患者互动平台的权限 预约提醒。成功完成拟议的研究将告知健康状况是否不同 根据心肌梗死的亚型，将探索多水平的干预是否可以增加CR的出勤率和 有可能改善2型心肌梗塞患者的健康状况。该研究奖的目的是：(1) 培养健康状况评估和患者报告结果衡量方面的专业知识，(2)学习如何 设计和解释患者和临床医生的调查，以及3)在临床试验设计、执行、 和解释。麦卡锡博士的职业目标是进行临床试验，以确定治疗方法 2型心肌梗死患者的治疗方法。这项提案的发现将构成Dr。 McCarthy的R01申请最终有效性--2型心肌梗死CR的实施试验。Dr。 麦卡锡的导师和科学顾问是CR、定性和定量研究、患者- 报告的结果衡量标准和临床试验。导师指导、正式课程和 拟议的研究将使麦卡锡博士成为一名独立的NIH调查员，而 提高有关如何改善2型心肌梗塞患者健康状况的知识。

Project Abstract Acute myocardial infarction (MI) is characterized by myocardial necrosis due to coronary ischemia and may be precipitated by several mechanisms. Coronary plaque rupture causes ‘type 1 MI,’ the subject of intense investigation for several decades and now with several therapies demonstrated to reduce mortality and improve health status. However, it is now recognized that at least 1 in 5 MIs are ‘type 2 MI,’ which occurs due to a mismatch in myocardial oxygen supply/demand precipitated by a preceding physiologic stress. Persons with type 2 MI are usually older and have more comorbidities than persons with type 1 MI. However, it is unknown whether these characteristic differences translate to differences in health status. Type 2 MI is associated with a poor prognosis; only 40% of individuals are alive at 5 years. Unfortunately, despite the frequency and prognosis of type 2 MI, evidence-based treatment strategies are lacking due to an absence of clinical trials. Exercise-based cardiac rehabilitation (CR) is demonstrably efficacious for type 1 MI. However, CR is virtually unused for type 2 MI. Increasing adoption of CR, a covered therapy, may improve outcomes for persons with type 2 MI. The aims of this research proposal are to (1) determine if differences exist in patient- reported health status between persons with type 2 versus type 1 MI, (2) obtain key information from patients and clinicians on the perceived benefits, acceptability, evidence requirement, and barriers to attendance at CR for type 2 MI compared to type 1 MI, and (3) undertake a pilot hybrid effectiveness-implementation clinical trial to assess if a multifaceted intervention increases attendance at CR and is potentially efficacious in improving health status for persons with type 2 MI as compared to usual care. For this latter aim, physicians will receive a reminder to consider referral to CR and patients will receive access to a patient engagement platform, with CR appointment reminders. Successful completion of the proposed studies will inform whether health status differs according to the subtype of MI and will explore if a multilevel intervention can increase CR attendance and potentially improve health status for those with type 2 MI. The objectives of this research award are to (1) develop an expertise in health status assessment and patient reported outcome measures, (2) learn how to design and interpret patient and clinician surveys, and 3) develop an expertise in clinical trial design, execution, and interpretation. Dr. McCarthy’s career goals are to undertake clinical trials that identify treatment approaches for individuals with type 2 MI. The findings from this proposal will form the foundation of Dr. McCarthy’s R01 application for a definitive effectiveness-implementation trial of CR for type 2 MI. Dr. McCarthy’s mentors and scientific advisors are experts in CR, qualitative and quantitative research, patient- reported outcome measures, and clinical trials. The combination of mentorship, formal coursework, and the proposed research studies will position Dr. McCarthy to become an independent NIH investigator while advancing knowledge on how to improve health status for persons with type 2 MI.