The long-term objectives for the proposed research and training plans are to provide a basis for the development of a K01 proposal that uses biobehavioral interventions to explore potential causal relationships among coping strategies, psychological distress, and health outcomes in adults with heart failure (HF). The proposed prospective, descriptive study will make use of Lazarus and Folkman's Coping Process Theory (1984) as an organizing framework, but will go beyond it to examine the relationships among coping strategies, depression, sympathetic nervous system activation, inflammatory cytokine production, and health outcomes in a stratified, quota sample of adults (N=150) living with HF who will be recruited from Vanderbilt Heart Institute. The longitudinal relationships among coping strategies, depressive symptoms, morbidity (re-hospitalization), and mortality (cardiac death) will be examined at three time points - baseline, 3, and 6 months. Biomarkers for SNS activation and cytokine production will be measured 4-6 weeks following baseline measures. The factors that influence changes in study variables over time will be examined and modeled using growth curve analyses and structural equation modeling. The associated training plan is designed to provide advanced training in advanced statistics, clinical immunology, and laboratory assay methods. These courses are offered through the Vanderbilt General Clinical Research Center's (GCRC) Master of Science in Clinical Investigation (MSCI) Program. This program was developed in order to train new physician and nurse clinical investigators in the techniques and processes utilized in patient-oriented research. This program is intended to provide direct, mentored experiences in clinical investigation and, through didactic work, to provide trainees with a strong foundation in study design, biostatistics, biomedical ethics, clinical pharmacology, human genetics, immunology, and assay methods. The results of the proposed study will provide a foundation for the development of an R01 application during year 3 of the award period. ? ? ?
