Optimizing Atrial Fibrillation Management in CKD

优化 CKD 中的房颤管理

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos 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

项目摘要

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失常，目前影响全球超过 3350 万成年人慢性肾脏病 (CKD) 也非常普遍，影响着 14% 的美国和北美人口。 CKD 患者的 AF 负担高出 3 倍，并且对 25% 的 AF 患者影响很大。与缺血性中风和死亡的风险相关；并且这些风险在 CKD 患者中甚至更高。即使没有临床缺血性中风，一些研究表明房颤也与所有痴呆类型的风险都很高，包括阿尔茨海默病和血管性痴呆，尽管有明确的证据阿尔茨海默病的特点是大脑的神经退行性改变，包括淀粉样蛋白。沉积和神经原纤维缠结 AF 可能导致脑微梗死、脑梗死。出血和脑血流量减少，所有这些都可能促进阿尔茨海默病和其他疾病更好地了解房颤与阿尔茨海默病和其他痴呆症的关系是对于 CKD 人群尤其重要，他们中痴呆症的发病率和患病率更高与一般人群相比，痴呆症的病因仍然难以捉摸，因此在很大程度上目前，有关 CKD 和 AF 患者患痴呆风险的数据有限，但可能提供一些信息。对 CKD 患者痴呆机制的新见解。此外，关于房颤治疗是否可以降低痴呆风险的数据在所有人群中都是相互矛盾的（无论 CKD 状况如何）虽然现有一些关于 AF 治疗和痴呆风险的研究，大多数都有局限性，包括（1）主要关注抗凝治疗，而不是综合评估其他 AF 治疗；(2) 纳入选定人群，且不纳入 CKD 人群；(3) 考虑不足；因此，可能影响 AF 治疗的接受和结果的临时临床措施的影响。房颤的成功治疗对痴呆风险的影响仍然很大程度上未知，进一步的数据可以确定新的。预防和治疗痴呆症的治疗方法。我们建议有效地利用我们独特的研究平台，其中包括“真实世界”的当代数据评估患有或不患有 CKD 的 AF 患者患痴呆的风险，并确定是否存在；通过综合疗法成功治疗房颤可降低患痴呆症的风险。开展这项工作时，我们将对超过 500,000 名患有和加利福尼亚州两个参与的医疗保健系统没有 AF，该拟议的补充项目将。为了解房颤和痴呆症之间的联系提供重要见解，特别是在高危人群中；此外，预期结果可以构成未来随机临床试验的基础。