Frailty and Resiliency in Older Adults with Acute Myocardial Infarction

患有急性心肌梗塞的老年人的虚弱和恢复能力

• 批准号: 10216336
• 负责人: Abdulla Al Damluji
• 金额: $ 18.31万
• 依托单位: INOVA HEALTH CARE SERVICES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10216336
• 关键词: Acute; Acute myocardial infarction; Address; Admission activity; Adult; Advocate; Age; Age-Years; Anemia; Award; Back; Benefits and Risks; Bioinformatics; Biometry; Blood flow; Capsicum; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical Trials; Clinical effectiveness; Coronary; Coronary Artery Bypass; Coronary heart disease; Data Collection; Decision Making; Development; Diagnostic; Disease; Educational workshop; Elderly; Environment; Epidemiologist; Evaluation; Experimental Designs; Exposure to; Foundations; Frail Elderly; Geriatrics; Gerontology; Goals; Grant; Guidelines; Health; Heterogeneity; High Prevalence; Hospitalization; Hypoalbuminemia; Impaired cognition; Impairment; Institutes; Internist; Intervention; Knowledge; Laboratories; Learning; Lower Extremity; Measurement; Measures; Medical; Medical Libraries; Medicare; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Office Management; Older Population; Operative Surgical Procedures; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Phenotype; Physicians; Physiological; Population; Prevalence; Procedures; Process; Prospective Studies; Public Health Schools; Research; Research Personnel; Research Proposals; Resistance; Resources; Retrospective cohort study; Risk; Role; Sampling; Syndrome; Testing; Time; Training Programs; United States; United States National Institutes of Health; Universities; University resources; Work; adverse outcome; age effect; base; beneficiary; care outcomes; career; clinical decision-making; clinical investigation; comparative effectiveness; design; diagnostic accuracy; disability; education research; evidence base; experience; follow-up; frailty; health related quality of life; improved; indexing; meetings; mortality; older patient; patient population; percutaneous coronary intervention; resilience; skills; standard of care; stressor; targeted treatment; tool; treatment choice; treatment response; young adult

The purpose of this research is to support the development of Dr. Abdulla Damluji into an independent investigator focused on studying geriatric syndromes during cardiovascular intervention. The K23 award will allow the development of a fundamental skillset including: the design and methods for analysis of interventions, understanding and proper application of frailty and resiliency assessments, designing pilot prospective studies, and enhancing knowledge of geriatrics and gerontology. Skills will be obtained through coursework, workshops, seminars, scientific meetings and mentored research. The overall goals are: 1) identify a simple universal bedside frailty test for clinical decision-making and 2) become an NIH-investigator prepared to conduct a clinical trial aimed to evaluate the comparative effectiveness of different treatments of acute myocardial infarction (AMI) in a heterogenous population of older adults living with frailty and lack of resiliency. Two thirds of all patients with cardiovascular disease (CVD) are older than 60 years of age, and >85% of patients over age 85 years live with some form of CVD. Of those older patients admitted with acute AMI, a majority experience frailty, a syndrome of decreased physiologic reserve and vulnerability to stressors. Moreover, some of these frail patients lack physical resiliency, the ability to rebound back and recover from a major health crisis. Critical “gaps in knowledge” in cardiovascular care for older adults, particularly those with frailty and lack of resiliency, have been identified. These “gaps” need to be addressed in order to provide the best possible care to a growing older patient population. This proposal examines the hypothesis that frailty and resiliency influence the treatment choice and health outcome after AMI. Aim1 evaluates the prevalence of frailty in U.S. among older AMI patients by treatment [percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, or guideline-directed medical therapy (GDMT)] using the validated claims-based frailty index. Aim 2 examines the role of frailty in treatment response to PCI and CABG. Aim 3 validates the diagnostic accuracy of a bedside 4-item frailty scale and assesses whether this diagnostic tool, used in combination with resiliency measurements, can predict health outcomes at 1-year follow-up. The institutional environments at both the Inova Heart and Vascular Institute (IHVI) and Johns Hopkins University (JHU) are ideal for conducting cardiovascular outcomes research. The mentorship consists of leaders with expertise directly relevant to the career goals of the applicant: Christopher M O’Connor, MD (IHVI; expert in experimental design); Dr Wayne Batchelor (IHVI: interventional cardiologist); Jodi B Segal, MD, MPH (JHU: internist/epidemiologist; expertise in clinical effectiveness), and Gary Gerstenblith (JHU: geriatric cardiology). Resources at IHVI include bioinformatics laboratory, grant management office, and a state-of-the-art research office. At JHU, resources include the Bloomberg School of Public Health, Graduate Training Program in Clinical Investigation, JHU Pepper Center Biostatistical and Research Education Cores, and the Welch Medical Library.

这项研究的目的是支持 Abdulla Damluji 博士发展成为一名 独立研究者专注于研究心血管干预期间的老年综合征。 K23 奖项将允许开发基本技能，包括： 分析干预措施、理解和正确应用脆弱性和复原力评估、设计 试点前瞻性研究，并通过提高老年病学和老年学技能来获得知识。 课程作业、讲习班、研讨会、科学会议和指导研究的总体目标是：1) 确定。 用于临床决策的简单通用床边衰弱测试，以及 2) 成为 NIH 研究者 进行一项临床试验，旨在评估不同治疗方法的比较有效性 心肌梗死（AMI）发生在身体虚弱且缺乏弹性的异质老年人群中。 三分之二的心血管疾病 (CVD) 患者年龄超过 60 岁，并且超过 85% 85 岁以上患有某种形式的 CVD 的患者中，有 1 名因急性 AMI 入院的老年患者。 大多数人都会经历虚弱，这是一种生理储备减少和容易受到压力源影响的综合症。 此外，其中一些虚弱的患者缺乏身体弹性，缺乏从疾病中恢复过来的能力。 老年人，特别是患有心血管疾病的老年人的心血管护理存在严重的“知识差距”。 已经确定了脆弱性和缺乏弹性，这些“差距”需要得到解决，以便提供 该提案检验了虚弱的假设。 AMI 评估后，弹性会影响治疗选择和健康结果。 美国老年 AMI 患者因治疗而虚弱的患病率 [经皮冠状动脉介入治疗 (PCI)、 冠状动脉搭桥术（CABG）手术，或指南指导的药物治疗（GDMT）]使用经过验证的 基于索赔的虚弱指数检查了虚弱在 PCI 和 CABG 治疗反应中的作用。 验证床边 4 项衰弱量表的诊断准确性，并评估该诊断工具是否 与弹性测量结合使用，可以预测一年随访时的健康结果。 Inova 心脏和血管研究所 (IHVI) 和约翰·霍普金斯大学的机构环境 大学 (JHU) 是进行心血管结果研究的理想场所。导师由领导者组成。 具有与申请人职业目标直接相关的专业知识：Christopher M O’Connor，医学博士（IHVI；专家 实验设计）；Wayne Batchelor 博士（IHVI：介入心脏病学家）；Jodi B Segal，医学博士、公共卫生硕士（JHU： 内科医生/流行病学家；临床有效性方面的专业知识）和 Gary Gerstenblith（JHU：老年心脏病学）。 IHVI 的资源包括生物信息学实验室、拨款管理办公室和最先进的研究 在约翰霍普金斯大学办公室，资源包括彭博公共卫生学院的临床研究生培训计划。 调查、JHU Pepper 中心生物统计和研究教育核心以及韦尔奇医学图书馆。