Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and the most common reason for hospitalization among older adults. Many patients with HF have symptoms at rest or with minimal exertion that become refractory to optimal medical therapy. Fewer than 5% of these advanced HF patients are eligible for heart transplantation, and organ donations are extremely limited. As such, mechanical circulatory support with a ventricular assist device (VAD) has emerged as a primary treatment for advanced HF. There is significant and unexplained heterogeneity in clinical outcomes and quality-of-life after VAD implantation. Moreover, we know very little about how physical and psychological symptoms may relate to changes in underlying HF pathogenesis and how symptoms and pathogenic biomarkers may explain differential responses to VAD implantation. Accordingly, our research goals are to a) characterize common and distinct trajectories of change in symptoms and pathogenic biomarkers during the transition from advanced HF through the first 6 months after VAD implantation, and b) link changes in symptoms and biomarkers over time to clinical events and quality-of-life. We will collect data from a cohort of 120 adults with advanced HF prior to, and for a period of 6 months after VAD implantation.
Our aims are to: 1) identify common trajectories of change in physical and psychological symptoms, 2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction, and 3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Importantly, we will codify the clinical relevance of different symptom and biomarker trajectories in terms of clinical-event risk and health-related quality-of-life. This interdisciplinary clinical research integrates and advances prior biological and behavioral research and is centered on an advanced technological treatment of a high profile cardiovascular disorder. These research findings will be used to enhance shared patient and provider decision-making regarding VAD implantation, and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation.

Public Health Relevance

This study involves a primary treatment for advanced heart failure, the fastest growing cardiovascular disorder in the United States. The results of this stud will be used to enhance patient and provider decision-making about advanced therapies for heart failure, and to develop personalized interventions to improve patient- oriented and clinical outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR013492-04
Application #
8824450
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Huss, Karen
Project Start
2012-04-01
Project End
2017-03-31
Budget Start
2015-04-01
Budget End
2017-03-31
Support Year
4
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Oregon Health and Science University
Department
Type
Schools of Nursing
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
Bidwell, Julie T; Lyons, Karen S; Mudd, James O et al. (2018) Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy. J Am Heart Assoc 7:
Denfeld, Quin E; Mudd, James O; Hasan, Wohaib et al. (2018) Exploring the relationship between ?-adrenergic receptor kinase-1 and physical symptoms in heart failure. Heart Lung 47:281-284
Lee, Christopher S; Gelow, Jill M; Chien, Christopher V et al. (2018) Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices. J Cardiovasc Nurs 33:144-151
Denfeld, Quin E; Habecker, Beth A; Woodward, William R (2018) Measurement of plasma norepinephrine and 3,4-dihydroxyphenylglycol: method development for a translational research study. BMC Res Notes 11:248
Bidwell, Julie T; Lyons, Karen S; Mudd, James O et al. (2017) Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers. J Cardiovasc Nurs 32:455-463
Lee, Christopher S; Mudd, James O; Gelow, Jill M et al. (2014) Background and design of the profiling biobehavioral responses to mechanical support in advanced heart failure study. J Cardiovasc Nurs 29:405-15
Nakahara, Shashima; Chien, Christopher; Gelow, Jill et al. (2013) Ventricular arrhythmias after left ventricular assist device. Circ Arrhythm Electrophysiol 6:648-54