Document text
Principal Investigator: David E Lanfear
Organization: WAYNE STATE UNIVERSITY
Fiscal Year: 2024
Award: $310,406
Funding agency: National Institute on Minority Health and Health Disparities
Abstract
Heart failure (HF) is one of the most common, costly, and deadly diseases affecting humans. Hypertension is the largest single risk factor for HF, accounting for over half of all new cases. Moreover, Black adults with hypertension have a much greater risk, perhaps 20-fold, of developing HF compared with White adults. Accordingly, early interventions to prevent HF, in particular blood pressure (BP) control, are critical. However, implementation of effective treatments remains suboptimal among Black communities, especially in Detroit, Michigan. To better engage our at-risk community, our team developed an innovative mobile health unit (MHU) program that uses geospatial health and area-level exposure data to direct health services to communities in highest need, who may not otherwise engage with traditional health care settings. Another key to preventing HF is usage of guideline-directed medical therapy (GDMT), not only for treating high BP, but also providing medications proven to reduce HF incidence. In particular, inhibitors of sodium-glucose transporter type 2 (SGLT2) prevent HF and loss of kidney function in at-risk patients and recent data suggests enhanced benefit in Black patients. Yet, these are dramatically under-utilized further contributing to health disparities. In Project 2 of ACHIEVE GREATER we will use a pragmatic, randomized, unblinded, clinical trial to implement and test a novel intervention leveraging our MHU platform to improve care access combined with enhanced collaborative care delivery among patients with Stage A HF (defined as asymptomatic individuals with known pre-conditions such as hypertension who are at-risk for later-stage clinical HF). The key components of our program are 1) a personalized intervention conducted by community health workers that links patients with available community resources, and 2) pharmacist-directed therapy optimization per a standardized GDMT protocol. This intervention will address multiple domains and levels of impact to reduce the large gaps in care of stage-A HF patients in the Black community and prevent progression towards symptomatic HF.
Terms: <21+ years old><Access to Care><Accounting><Active Follow-up><Address><Adult><Adult Human><Affect><Application Context><BNP Gene Product><BNP-32><BP control><BP management><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Blood Pressure><Brain Natriuretic Peptide-32><Brain natriuretic peptide><COVID testing><COVID-19 testing><COVID19 testing><Cardiac Abnormalities><Cardiac Diseases><Cardiac Disorders><Caring><Clinical><Clinical Trials><Communities><Community Health Aides><Data><Death Rate><Decrease health disparities><Diabetes Mellitus><Disease><Disorder><Drug Therapy><Drugs><Early Intervention><Echocardiogram><Echocardiography><Effectiveness><Employment><Environment><Event><Glucose Binding Protein><Glucose Transport Protein><Glucose Transporter><Great Lakes Region><Guidelines><Health><Health Inequity><Health Services><Health Services Accessibility><Health disparity mitigation><Health disparity reduction><Heart Abnormalities><Heart Diseases><Heart failure><History><Human><Hypertension><Incidence><Individual><Inequalities in Health><Inequities in Health><Intervention><Intervention Strategies><Kidney Diseases><Length><Life><Life Style><Lifestyle><Link><Low income><Lower health disparities><Maintenance><Medical><Medication><Methods><Mitigate health disparities><Mobile Health Units><Modern Man><Na element><Natriuretic Factor-32><Neighborhoods><Nephropathy><Nesiritide><Outcome><PRISM framework><PRISM model><Participant><Patients><Persons><Pharmaceutical Preparations><Pharmacists><Pharmacotherapy><Phase><Physical activity><Population><Practical Robust Implementation and Sustainability Model><Pragmatic, Robust Implementation and Sustainability Model><Prevention><Protocol><Protocols documentation><Randomization trial><Randomized><Recommendation><Recording of previous events><Reduce health disparities><Renal Disease><Renal function><Renin-Angiotensin System><Research><Research Resources><Resources><Risk><Risk Factors><SARS-CoV-2 testing><Sodium><Target Populations><Testing><Transthoracic Echocardiography><Type-B Natriuretic Peptide><Vaccinated><Vaccination><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><active followup><adulthood><availability of services><barriers to implementation><black patient><blood pressure control><blood pressure management><brain Natriuretic factor><cardiac failure><cardiac function><cardiometabolic><cardiometabolism><care access><care delivery><clinical care><co-morbid><co-morbidity><collaborative care><community health worker><community level disadvantage><community partners><community-based partners><comorbidity><contextual factors><coronavirus disease 2019 testing><coronavirus disease testing><coronavirus testing><cost><cost effectiveness><diabetes><disadvantaged community><disparity in health><drug treatment><drug/agent><effective therapy><effective treatment><follow up><follow-up><followed up><followup><food insecurity><function of the heart><health care access><health care availability><health care service access><health care service availability><health care settings><health disparity><health equity><health inequalities><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><healthcare settings><heart disorder><heart function><heart sonography><high blood pressure><histories><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><hypertensives><implementation barriers><implementation challenges><improved><inhibitor><innovate><innovation><innovative><interventional strategy><kidney disorder><kidney dysfunction><kidney function><mortality rate><mortality ratio><neighborhood barrier><neighborhood disadvantage><neighborhood-level barrier><neighborhood-level disadvantage><novel><outreach><personalized health intervention><personalized intervention><precision interventions><prevent><preventing><primary outcome><programs><randomisation><randomization><randomized trial><randomly assigned><recruit><renal disorder><renal dysfunction><screening><screenings><service availability><severe acute respiratory syndrome coronavirus 2 testing><social><social health determinants><social vulnerability><standardize guidelines><testing for COVID><testing of COVID><therapy optimization><treatment access><treatment optimization><urban environment><urban setting>