Differential Impacts of Person and System Level Determinants of Health on Dyadic Heart Failure Management: The IMPACT-D Study

Heart failure (HF) is the fastest-growing cardiovascular disorder and a leading cause of urgent healthcare utilization in the U.S. Effective HF physical self-care (i.e. behaviors that maintain physiologic stability (self-care maintenance), monitor for changes in signs and symptoms (self-care monitoring), and respond to symptoms

when they occur (self-care management)) has been linked with better patient-reported, biological and clinical outcomes. However relatively little is known about mental health self-care in HF. In addition, a growing body of research includes informal care partners (e.g. family members who engage in an unpaid shared partnership in

care) increasing the need for a critical examination of the differential impact of physical and mental health of both care partners on HF management; but, this is an emerging area of science. As managing HF at home has increased in intensity/complexity, the mental health impact is of growing importance. Similarly, there are well-

known inequities and major advocacy calls to study social determinants of health in HF (i.e. race, ethnicity, gender, economic resources, education, occupation and discrimination). Before we can intervene effectively, however, we need to learn more from people with HF and their care partners about what they do to manage HF,

and how they maintain, monitor and manage their mental health. The proposed study addresses identified gaps in both precision (mental health) and population (social determinants) health sciences. Accordingly, the goals of this prospective, dyadic- and social determinants of health theory-informed study of 100 dyads are to gain insight

into the role that social determinants of health play as the root causes of some of the inequities about which we know, and additional inequities we are likely to discover in this study. Specifically, we will quantify the relationships between both symptoms and social determinants of health and contributions to care in people with

HF and their care partners (Aim 1), and then characterize people with HF and care partner contributions to the maintenance, monitoring and management of mental health (Aim 2). Importantly, each aim is strongly rooted with hypotheses of social determinants of health or preliminary data that suggest we will be successful in

achieving these aims. The results of this study will have an important and enduring influence on future theoretical modification (embedding the dyad and mental health in “self”-care theory), measurement (centering the dyad), and interventional development to promote optimal physical and mental health among HF dyads. Our long-term

goal is greater parity between physical and mental health in theoretical, measurement, and interventional domains of HF management.