The Role of Circadian Disruption and Disordered Sleep in Heart Failure Risk and Management among Rural Adults - PROJECT SUMMARY/ABSTRACT The overall goal of the 5-year K23 proposal is to support Brittanny Polanka, PhD to become an independent clinical investigator with a program of research in cardiovascular behavioral medicine. Heart failure (HF) is a progressive and life-threatening illness projected to impact ~8 million U.S. adults by 2030. Using the American College of Cardiology/American Heart Association HF staging system, between 22-52% of U.S. adults have at least one HF risk factor (Stage A), an additional 24-43% have associated asymptomatic heart disease (Stage B), and 25% of U.S. adults will develop HF (Stage C/D) over their lifetime. Despite advances in therapeutics, HF is incurable and carries a staggering 75% 5-year mortality rate. Thus, there remains an urgent need to address modifiable risk factors driving progression from Stages A/B to Stages C/D and complicating factors driving mortality risk in Stages C/D. Circadian disruption and disordered sleep are two such modifiable, yet unappreciated factors that are linked to the development of HF and may serve as potential targets to reduce HF risk and improve HF management. However, several important gaps remain with a continued need to a) characterize circadian disruption and disordered sleep by HF Stage, b) understand their consequences on mechanisms of HF Stage progression, and c) examine whether intervening upon these factors can delay or prevent HF Stage progression. These knowledge gaps are more pronounced for the rural South population, which is disproportionately burdened by higher HF risk and related mortality compared to both urban counterparts and other geographic regions. This K23 proposal seeks to address these key knowledge gaps using a mixed methods approach. First, we will leverage the Risk Underlying Rural Areas Longitudinal (RURAL) Study to quantitatively describe and qualitatively understand circadian disruption and disordered sleep and their influence on pathways contributing to HF Stage progression and poor HF outcomes among rural-dwelling adults in the Southern U.S. (Aims 1-2). Next, we will use these data to inform the adaptation and pilot testing of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for rural-dwelling adults at risk for and living with HF (Aim 3). To complete the proposed research and advance Dr. Polanka’s career trajectory, she and her team of mentors in behavioral sleep medicine (S. Justin Thomas, PhD), behavioral clinical trials (Gareth Dutton, PhD), mixed methods (Nataliya Ivankova, PhD), and geriatric cardiology (Parag Goyal, MD) have curated a career development plan to address training objectives in a) mixed methods, b) behavioral clinical trials, c) conduct of observational and interventional research with attention to multimorbidity and aging, and d) professional development and transition to independence. The research aims of this proposal directly align with the NHLBI Strategic Goals and Objectives related to cardiometabolic risk management in specific populations (3.CQ.05) and circadian-based strategies for improving efficacy in heart, lung, blood, and sleep disorders (5.CQ.05).
