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.
Physical activity is safe and clinically recommended for most patients with implantable cardioverter defibrillators (ICDs) yet women are among the least active ICD patients and have an excess mortality risk due to inactivity. This study will provide novel insights about gender differences in the patterns, barriers, risk factors and preferences for activity after ICD implant, and will explore safe and risk lowering levels of activity for men and women with ICDs. Information from this study will be critical to development of a future physical activity intervention tailored to meet the needs, goals and expectations of women with ICDs.
