The Atrial Fibrillation - Factor Identification to Risk Modification Study in HD

心房颤动 - HD 风险调整研究的因素识别

• 批准号: 8372215
• 负责人: WOLFGANG CHRISTOPH WINKELMAYER
• 金额: $ 50.42万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8372215
• 关键词: Adult; Affect; Age; Algorithms; American; Arrhythmia; Atrial Fibrillation; Berlin; Bioinformatics; Biometry; Blood Pressure; C-reactive protein; Calcium; Cardiovascular system; Caring; Catheters; Caucasoid Race; Cessation of life; Characteristics; Clinical; Comorbidity; Coronary heart disease; Data; Data Set; Databases; Deltastab; Diabetes Mellitus; Diagnosis; Dialysis patients; Dialysis procedure; Digestive System Disorders; Elderly; Electrocardiogram; Electrolytes; Electronic Health Record; End stage renal failure; Environment; Ethnic Origin; Excision; Funding; Health; Health Care Costs; Healthcare; Heart Atrium; Heart Rate; Heart Valve Diseases; Heart failure; Hematological Disease; Hemodialysis; Hemoglobin; Hispanics; Hormones; Hospitalization; Hypotension; Incidence; Institutes; Insurance; Intervention; Intervention Studies; Ischemic Stroke; Kidney; Kidney Diseases; Laboratories; Lead; Left; Life; Link; Liquid substance; Maintenance; Measurement; Measures; Medical Records; Medicare; Medicare claim; Methods; Mission; Modification; Morbidity - disease rate; Myocardial Infarction; Nutritional status; Outcome; Parathyroid gland; Patient Care; Patient Outcomes Assessments; Patients; Peripheral; Phosphorus; Population; Positioning Attribute; Potassium; Prevalence; Preventive; Proteins; Provider; Quality of Care; Questionnaires; Recurrence; Renal dialysis; Reporting; Research; Risk; Risk Factors; Serum Albumin; Serum Calcium Level; Shapes; Sleep Apnea Syndromes; Sodium; Stroke; System; Testing; Thromboembolism; Time; Treatment Factor; Urea; Urologic Diseases; Variant; Work; base; clinically relevant; cost; experience; health care service utilization; health related quality of life; high risk; improved; indium arsenide; innovation; instrument; interest; longitudinal database; low socioeconomic status; male; modifiable risk; mortality; novel; older patient; patient population; physical conditioning; point of care; prevent; treatment duration; trend

DESCRIPTION (provided by applicant): More than 575,000 Americans have end-stage renal disease, and more than 350,000 receive life-saving dialysis treatment. Previous research has demonstrated that patients undergoing hemodialysis, especially those who are older, are at particular risk to have atrial fibrillation. Atrial fibrillation is associated with poor outcomes including high mortality (40% per year). Little is known about fixed and potentially modifiable ris factors for atrial fibrillation in older patients receiving hemodialysis; there is also only scant evidence about these patients' outcomes after their first diagnosis with atrial fibrillation. From already collected Medicare insurance claims and medical records of a large dialysis provider, we propose to assemble a unique dataset that will provide unprecedented detail about these patients health and the health care they receive. In addition, we will have historical Medicare claims predating these patients' time of dialysis initiation by at least 2 years. Using this unique database, we will be in the unusual situation to be able to exclude patients who had atrial fibrillation before they started dialysis, and therefore be able to study incident atrial fibrillaton. We are proposing to identify potentially modifiable risk factors for incident atrial fibrillation, ith particular focus on laboratory measurements, vital signs, dialysis treatment- related factors, and dialysis facility practices. We will also launch a comprehensive assessment of the outcomes of patients once they are first diagnosed with atrial fibrillation, in comparison to similar patients who have not developed this arrhythmia. Outcomes of interest will cover all relevant domains: all-cause and cause-specific mortality; morbidity with focus on thromboembolic and hemorrhagic outcomes; patient-reported health-related quality of life outcomes; and health care utilization and cost. These studies will fill gaping holes in the currently available evidence. The perhaps most innovative aim will focus on deriving a prediction algorithm for near-term risk of new atrial fibrillation using the high-dimensional and extremely granular data in our dataset and novel bioinformatic methods. We will then validate the algorithm in a completely different later time period in data from the same provider as well as in another dataset from a different dialysis provider. If our approach proves successful in identifying patients at the highest near-term risk of incident atrial fibrillation, we are then in the position to test intervention studies to reducethe risk of imminent atrial fibrillation and thus avoid longer term sequelae of this arrhythmia in thes vulnerable patients. Findings from the proposed work have the potential to impact and improve the care that patients with end-stage renal disease receive. Our results may improve the quality of care received and, thus, the outcomes of this vulnerable patient population. The aims and scope of work are in full congruence with the mission of the National Institutes of Diabetes and Digestive and Kidney Diseases, and more specifically the Division of Kidney, Urologic, and Hematologic Diseases, which will consider this application for funding. PUBLIC HEALTH RELEVANCE: The kidneys of more than 575,000 Americans have irreversibly stopped working, which renders these patients dependent on receiving regular kidney dialysis. Atrial fibrillation is a common type of irregular heartbeat, but patients receivin kidney dialysis are particularly often affected. Atrial fibrillation may lead to stroke or death ina large proportion of these patients and therapies to reverse it or to prevent bad outcomes do not appear to work in dialysis patients. We propose to identify possibly preventable factors that make patients develop atrial fibrillation in the first place. This information will help identify hgh-risk patients in whom preventive measures can then be tested.

描述（由申请人提供）：超过575,000名美国人患有末期肾脏疾病，超过350,000名接受了挽救生命的透析治疗。先前的研究表明，接受血液透析的患者，尤其是年龄较大的患者，患有房颤的风险尤其有。心房颤动与较差的结局有关，包括高死亡率（每年40％）。关于接受血液透析的老年患者的固定且潜在的可修改RIS因子的固定且潜在的可修改RIS因子知之甚少。对于这些患者首次诊断出心房颤动后的结果也只有很少的证据。 从 我们已经收集了大型透析提供者的Medicare保险索赔和病历，我们建议组装一个独特的数据集，该数据集将提供有关这些患者健康和他们接受的医疗保健的前所未有的细节。此外，我们还将有历史性的医疗保险主张，这些主张至少在这些患者的透析开始至少2年之前。使用这个独特的 数据库，我们将处于不寻常的情况，能够在开始透析之前排除患有房颤的患者，因此能够研究事件的心房纤维化。 我们提议确定可能改变的事件房颤危险因素，特别关注实验室测量，生命体征，透析治疗 - 相关因素和透析设施实践。与未患上这种心律不齐的类似患者相比，我们还将对患者的结局进行全面评估。感兴趣的结果将涵盖所有相关领域：全原因和特定原因的死亡率；发病率侧重于血栓栓塞和出血结果；与患者报告的与健康相关的生活质量结果；以及医疗保健利用和成本。这些研究将在当前可用的证据中填补空调。也许最具创新性的目标将集中在我们数据集中的高维和极其颗粒状的数据以及新颖的生物信息学方法中使用高维和极其颗粒状数据的新房颤风险的预测算法。然后，我们将在同一提供商的数据以及来自不同透析提供商的另一个数据集中的数据中验证该算法。如果我们的方法被证明成功地识别出最高的近期发生房颤风险的患者，那么我们就可以测试干预研究以降低即将发生的心房颤动的风险，从而避免这种心律失常的长期后遗症。 。 拟议工作的发现有可能影响和改善终末期肾脏疾病患者接受的护理。我们的结果可能会提高收到的护理质量，从而提高该脆弱患者人群的结果。工作的目的和范围与美国国立糖尿病，消化和肾脏疾病的使命完全一致，更具体地说是肾脏，泌尿科和血液学疾病的部门，这将考虑这项资金申请。 公共卫生相关性：超过57.5万名美国人的肾脏不可逆转地停止工作，这使这些患者依赖于常规肾脏透析。心房颤动是一种不规则心跳的常见类型，但患者应收肾脏透析通常受到尤其影响。心房颤动可能导致中风或死亡，其中很大一部分患者和疗法可以扭转或预防不良预后，似乎在透析患者中​​没有起作用。我们建议确定可能使患者首先发展心房颤动的可能预防因素。此信息将有助于确定可以对预防措施进行测试的HGH风险患者。