Risk Stratification in Older Persons with Acute Myocardial Infarction: SILVER-AMI

老年人急性心肌梗塞的风险分层：SILVER-AMI

• 批准号: 8532980
• 负责人: Sarwat I Chaudhry
• 金额: $ 227.32万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-18 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8532980
• 关键词: Accounting; Acute myocardial infarction; Address; Adoption; Adult; Age; Age-Years; Aging; Automobile Driving; Cardiology; Cardiovascular system; Caregivers; Caring; Clinical; Clinical Research; Cognition; Complex; Data; Decision Making; Development; Disease; Early treatment; Elderly; Enrollment; Etiology; Event; Foundations; Gait; Generations; Geriatric Assessment; Geriatrics; Health Status; Heterogeneity; Hospitalization; Hospitals; Impaired cognition; Impairment; Interview; Maintenance; Measures; Medical; Medicine; Methodology; Methods; Modeling; Morbidity - disease rate; Mortality Decline; Myocardial Infarction; Observational Study; Outcome; Participant; Patient-Focused Outcomes; Patients; Persons; Physical Function; Physicians; Physiological; Population; Practice Guidelines; Prevalence; Process; Recovery; Research; Risk; Risk Assessment; Risk Factors; Role; Speed; Stratification; Woman; Work; adverse outcome; age group; aging population; cardiovascular risk factor; clinical care; clinical decision-making; clinical practice; clinical risk; design; high risk; hospital readmission; improved; insight; interest; meetings; men; model design; mortality; multiple chronic conditions; muscle strength; neglect; older patient; outcome forecast; patient population; shared decision making; therapy development; tool

DESCRIPTION (provided by applicant): Among patients presenting with acute myocardial infarction (AMI), 30% are 75 years or older, and this prevalence is expected to increase with the aging of the baby-boomer generation. Their high burden of comorbid conditions and concomitant lower physiologic reserve render this group more complex and fundamentally different from younger AMI patients. Risk stratification models are helpful for medical decision making in the post-AMI period as patients judged to be at higher risk may receive more aggressive surveillance and/or earlier treatment, while patients estimated to be at lower risk may be reassured and managed less aggressively. Currently available post-AMI risk models were developed using data from younger patients, and they do not perform well in older patients. While there is emerging interest in understanding the role of geriatric conditions (including impairments in cognition and muscle strength) as they pertain to cardiovascular outcomes, there is no standard, feasible assessment of older patients with AMI that can stratify their risk of subsequent morbidity and mortality. Furthermore, currently available risk models are designed solely to predict clinical events (e.g., mortality). This is insufficient for shared decison making with older patients, who consistently rate maintenance of favorable health status (including physical function) as a top priority. This proposal will address these gaps by melding principles from geriatrics and cardiology to create post-AMI risk models specifically designed for older patients. We propose the first, large (N=3000), observational, mixed- methods study (combining both quantitative and qualitative methodology) of the older AMI population, SILVER- AMI. The overall objective of this study is to develop and validate risk stratification tools for oder adults with AMI. We will consecutively screen men and women age 75 years and older hospitalized with AMI to enroll participants from a national network of hospitals that are working with us in a nearly completed large-scale observational study of AMI in younger persons (VIRGO). All risk factors will be assessed prior to hospital discharge, and all outcomes will be assessed 6-months later. Given the dearth of information to understand use of risk stratification tools by physicians, we will conduct in-depth interviews with physicians to assess facilitators and barriers to adoption of new risk stratification tools. This information will guide the development f the tools we develop to maximize the likelihood that they are used in clinical practice. The tools we develop will be feasible for use in routine clinical care (i.e. take 15 minutes or less to calculate scores), consider previously neglected risk factors, predict both clinical and patient-centered outcomes, and will be informed by insights of the end-users (i.e., physicians caring for older patients hospitalized with AMI). To meet the needs of the aging population, a new clinical paradigm is needed- one that starts with a comprehensive assessment of risk for clinical and patient-centered outcomes, and then tailors therapy and surveillance to each patient's risk. This is foundational work: a prerequisite to tailoring post AMI recovery strategies for older patients.

描述（由申请人提供）：在出现急性心肌梗塞（AMI）的患者中，30％的年龄为75岁或以上，并且随着婴儿潮一代的衰老，这种患病率预计会增加。它们的合并症的高负担和伴随的较低生理储备使该组变得更加复杂，并且与年轻的AMI患者根本不同。风险分层模型有助于在AMI后期的医疗决策中，因为判断患者处于较高的风险可能会受到更积极的监视和/或更早的治疗，而估计有较低风险的患者可能会受到放心，并且积极地管理较低的风险。目前使用来自年轻患者的数据开发了AMI后风险模型，并且在老年患者中表现不佳。尽管与心血管结局有关的老年疾病的作用（包括认知和肌肉力量的损害）引起了人们的兴趣，但没有对AMI老年患者的标准，可行的评估，可以分层其随后的发病率和死亡率。此外，目前可用的风险模型仅旨在预测临床事件（例如死亡率）。这对于与老年患者共同制造的共同修剪不足，他们始终将有利的健康状况（包括身体机能）评为重中之重。该建议将通过融合老年医学和心脏病学原理来解决这些差距，以创建专门为老年患者设计的AMI后风险模型。我们提出了第一个，大的（n = 3000），观察性的，混合方法研究（结合了年龄较大的AMI种群的定量和定性方法论），Silver-Ami。这项研究的总体目的是为AMI的Oder成年人开发和验证风险分层工具。我们将连续筛查75岁及以上的男女与AMI住院，以招募来自国家医院网络的参与者，这些医院网络正在与我们合作，对年轻人（Virgo）的AMI进行了几乎完成的大规模观察研究。所有危险因素将在出院前评估，所有结果将在6个月后评估。鉴于医生了解风险分层工具的使用缺乏，我们将对医生进行深入的访谈，以评估促进者和 采用新风险分层工具的障碍。该信息将指导我们开发的工具的开发，以最大程度地利用它们在临床实践中使用。我们开发的工具可用于常规临床护理（即花费15分钟或更短的时间来计算得分），考虑先前被忽视的危险因素，预测以临床和患者为中心的结果，并通过最终用户的见解（即，在AMI住院住院的老年患者）的见解（即，洞察力）。为了满足老龄化人群的需求，需要一个新的临床范式 - 首先要全面评估以临床和患者为中心的结果的风险，然后对每个患者的风险量身定制治疗和监视。这是基本工作：为老年患者量身定制AMI恢复策略的先决条件。