Optimizing Atrial Fibrillation Management in CKD

优化 CKD 中的房颤管理

• 批准号: 10287433
• 负责人: Nisha Bansal
• 金额: $ 40.94万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10287433
• 关键词: Adult; Affect; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; Amyloid deposition; Anticoagulants; Anticoagulation; Arrhythmia; Atrial Fibrillation; Award; Brain; California; Cerebral hemisphere hemorrhage; Cerebrovascular Circulation; Chronic Kidney Failure; Clinical; Communities; Conflict (Psychology); Data; Dementia; Development; Evaluation; Funding; Future; General Population; Healthcare Systems; Heart Rate; Incidence; Ischemic Stroke; Kidney Diseases; Lead; Link; Machine Learning; Measures; Natural Language Processing; Nerve Degeneration; Neurofibrillary Tangles; Oral; Outcome; Parents; Patients; Pharmaceutical Preparations; Population; Prevalence; Prevention approach; Procedures; Randomized Clinical Trials; Research; Rest; Risk; Sinus; Vascular Dementia; Warfarin; Work; cerebral microinfarct; cohort; comparative effectiveness analysis; dementia risk; high dimensionality; high risk population; insight; mortality risk; novel therapeutic intervention; population based; response; success; therapy adverse effect; vascular risk factor

ABSTRACT Atrial fibrillation (AF) is the most common sustained arrhythmia, currently affecting >33.5 million adults world- wide. Chronic kidney disease (CKD) is also highly prevalent and affects 14% of the U.S. and North American population. The burden of AF is 3-fold higher in CKD and affects up to 25% of CKD patients. AF is strongly associated with risk of ischemic stroke and death; and these risks are even higher in patients with CKD. Even in the absence of clinical ischemic stroke, some studies have suggested that AF is also associated with excess risks of all dementia types, including Alzheimer’s and vascular dementia, although definitive evidence is lacking. Alzheimer's disease is characterized by neurodegenerative changes in the brain, including amyloid depositions and neurofibrillary tangles. It is plausible that AF may lead to cerebral microinfarcts, cerebral hemorrhage and reduced cerebral blood flow, all which could promote Alzheimer’s disease and other dementias. Gaining a greater understanding of the association of AF with Alzheimer’s and other dementias is particularly important in the CKD population, in whom the incidence and prevalence of dementia is even higher compared with the general population; and in whom the cause of dementia remains elusive and thus largely untreated. Currently, data on the risk of dementia in patients with CKD and AF are limited and may provide new insight into the mechanisms that contribute to dementia in CKD patients. Further, data on whether treatment of AF mitigates risk of dementia are conflicting in all populations (regardless of CKD status). While there are some existing studies of treatment of AF and risk of dementia, most have limitations, including (1) a primary focus on anticoagulation and not a comprehensive evaluation of other AF therapies; (2) inclusion of selected populations and none with CKD; and (3) inadequate consideration of interim clinical measures that may affect receipt and outcomes of AF therapies. Therefore, the effects of successful treatment of AF on risk of dementia remains largely unknown. Further data could identify novel therapeutic approaches for the prevention and treatment of dementia. We propose to efficiently leverage our unique research platform that includes “real-world” contemporary data to evaluate the risk of dementia in patients with AF, with and without CKD; as well as determine whether successful treatment of AF with a comprehensive range of therapies is linked to a lower risk of dementia. To conduct this work, we will perform a rigorous comparative effectiveness analysis of >500,000 patients with and without AF from two participating health care systems in California. This proposed supplemental project will yield key insights to understanding the link between AF and dementia; particularly in the high-risk population of those with CKD. Furthermore, the anticipated results could form the basis of future randomized clinical trials.

抽象的 心房颤动（AF）是最常见的持续性心律不齐，目前影响3350万成人世界 - 宽的。慢性肾脏疾病（CKD）也很普遍，影响了美国和北美的14％ 人口。 CKD的AF燃烧高3倍，最多影响25％的CKD患者。 AF强烈 与缺血性中风和死亡的风险有关； CKD患者的这些风险甚至更高。 即使在没有临床缺血性中风的情况下，一些研究也表明AF也与 所有痴呆症类型的过多风险，包括阿尔茨海默氏症和血管痴呆，尽管确定性证据是 缺乏。阿尔茨海默氏病的特征是大脑的神经退行性变化，包括淀粉样蛋白 沉积和神经纤维缠结。 AF可能导致脑微感染，大脑是合理的 出血和脑血流降低，所有这些都可以促进阿尔茨海默氏病和其他 痴呆症。对AF与阿尔茨海默氏症和其他痴呆症的关联有了更大的了解是 在CKD人群中尤为重要，其中痴呆症的事件和患病率更高 与一般人群相比；痴呆症的原因仍然难以捉摸，因此很大程度上 未经处理。目前，有关CKD和AF患者痴呆风险的数据有限，可能会提供 对CKD患者有助于痴呆的机制的新见解。 此外，有关AF治疗是否减轻痴呆症的风险的数据在所有人群中都矛盾 （无论CKD状态如何）。尽管有一些现有的有关AF治疗和痴呆症风险的研究，但 大多数都有局限性，包括（1）主要关注抗凝，而不是对 其他AF疗法； （2）包含选定的人群，而没有CKD； （3）考虑不足 可能影响AF疗法的收入和结果的临床措施。因此， 在痴呆症风险上成功治疗AF仍然很大程度上是未知的。进一步的数据可以识别出新颖 预防和治疗痴呆的治疗方法。 我们建议有效利用包括“现实世界”当代数据在内的独特研究平台 评估患有AF，有或没有CKD患者的痴呆症风险；以及确定是否 通过全面疗法的AF成功治疗与降低痴呆症的风险有关。到 进行这项工作，我们将对> 500,000例患者进行严格的比较有效性分析 没有来自加利福尼亚两个参与医疗保健系统的AF。这个拟议的补充项目将 产生关键的见解，以了解AF和痴呆症之间的联系；特别是在高危人群中 那些带有CKD的人。此外，预期的结果可能构成将来随机临床试验的基础。