PROARRHYTHMIC MEDICINES AND PRIMARY CARDIAC ARREST

促心律失常药物和原发性心脏骤停

• 批准号: 2332486
• 负责人: DAVID Stuart SISCOVICK
• 金额: $ 36.39万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-01-01 至 1999-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2332486
• 关键词: antiarrhythmic agent; anticonvulsants; antidepressants; beta antiadrenergic agent; chemical information system; disease /disorder proneness /risk; dosage; drug adverse effect; drug interactions; electrocardiography; heart arrest; heart conduction system; heart disorder chemotherapy; human data; human morbidity; hypertrophic myocardiopathy; longitudinal human study; medical records

This proposal represents a second revision of a competing renewal of ROI HL 42456-O3 entitled, "Antihypertensive Therapy and Primary Cardiac Arrest". Unexpected findings from the Cardiac Arrhythmia Suppression Trial--an adverse effect on mortality of two antiarrhythmic drug therapies---have heightened concerns that other drug therapies may increase the risk of primary cardiac arrest. To determine whether treatment with antidepressant, anticonvulsant, and antiarrhythmic drugs- therapies that have the potential for proarrhythmia-increase the risk of primary cardiac arrest, we propose to conduct a population-based case- control study nested within a cohort of patients who receive medical care at a large pre-paid Health Care Plan in Seattle (Washington). Cases are patients who had a primary cardiac arrest between 1977 to 1994. Controls are a stratified random sample of patients, frequency-matched to cases by age, gender, calendar-year, and known heart disease. Treatment with drugs will be assessed through a computerized pharmacy database. Ambulatory-care medical records will be reviewed to assess clinical characteristics, including the indication for therapy, the severity of heart disease, co- existing morbidity, and other risk factors. For both antidepressant and anticonvulsant drugs, analyses will be stratified by known heart disease, because the risk of treatment may be particularly large among patients with known heart disease. For antiarrhythmic drugs, analyses will be restricted by a single, current indication for the therapy--maintenance of sinus rhythm among patients with chronic atrial fibrillation; and, by the availability of a prior echocardiogram, in order to control for the type and severity of underlying heart disease. After adjustment for potential confounders, we will estimate the risk of primary cardiac arrest among patients treated with a drug as compared to patients who are not treated. We also will examine the relative safety of: 1) drugs within the same therapeutic class; and, 2) the dosage schedule for specific drugs. In addition, we will determine if concurrent treatment with other drugs that alter cardiac conduction or morbidity that alters drug disposition influences the risk among patients treated with a drug therapy. Although we expand the scope of research, the proposed research builds directly upon resources and methods developed during the initial funding period.

该提案代表了 ROI 竞争更新的第二次修订 HL 42456-O3，标题为“抗高血压治疗和原发性心脏病 逮捕”。心律失常抑制的意外发现 试验——两种抗心律失常药物对死亡率的不良影响 疗法——人们更加担心其他药物疗法可能 增加原发性心脏骤停的风险。判断是否 抗抑郁药、抗惊厥药和抗心律失常药物治疗- 可能导致心律失常的疗法——增加以下风险 原发性心脏骤停，我们建议进行一项基于人群的案例- 对照研究嵌套在接受医疗护理的患者队列中 西雅图（华盛顿）的一项大型预付费医疗保健计划。案例有 1977 年至 1994 年间发生原发性心脏骤停的患者。 是患者的分层随机样本，与病例进行频率匹配 年龄、性别、历年和已知的心脏病。药物治疗 将通过计算机化药房数据库进行评估。门诊护理 将审查医疗记录以评估临床特征， 包括治疗适应症、心脏病的严重程度、 现有的发病率和其他风险因素。对于抗抑郁药和 抗惊厥药物，分析将按已知的心脏病进行分层， 因为患者的治疗风险可能特别大 患有已知的心脏病。对于抗心律失常药物，分析将是 受当前单一治疗适应症的限制——维持 慢性心房颤动患者的窦性心律；并且，由 先前的超声心动图的可用性，以便控制类型 以及潜在心脏病的严重程度。调整潜力后 混杂因素，我们将估计原发性心脏骤停的风险 接受药物治疗的患者与未接受治疗的患者进行比较。 我们还将检查以下方面的相对安全性：1）同一药物中的药物 治疗类；以及，2) 特定药物的剂量表。在 此外，我们将确定是否与其他药物同时治疗 改变心脏传导或改变药物处置的发病率 影响接受药物治疗的患者的风险。虽然 我们扩大研究范围，拟议的研究直接建立 根据初始资助期间开发的资源和方法。