Atrial Fibrillation in Sepsis: Patient Outcomes and Provider Practice Patterns

脓毒症中的心房颤动：患者结果和提供者实践模式

• 批准号: 8617298
• 负责人: Allan J. Walkey
• 金额: $ 13.43万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-12 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8617298
• 关键词: Acute; Address; Adult; Affect; Age; American; Anticoagulation; Atrial Fibrillation; Award; Benefits and Risks; Biometry; Cardiovascular system; Cause of Death; Cessation of life; Clinical; Clinical Trials; Clinical Trials Design; Collaborations; Critical Illness; Data; Data Set; Data Sources; Databases; Diagnosis; Disease; Drug Utilization; Educational process of instructing; Elderly; Epidemiologic Methods; Epidemiology; Foundations; Future; Geography; Goals; Health Care Costs; Health Services; Heart Atrium; Heart Diseases; Heart Rate; Heart failure; Hematological Disease; Hemorrhage; Hospital Mortality; Hospitalization; Hospitals; Incidence; Inflammation; Inflammatory; Inpatients; Intervention; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Leadership; Learning; Literature; Lung diseases; Medicare; Mentors; Mentorship; Meta-Analysis; Metabolic; Methods; Mission; Modification; National Heart, Lung, and Blood Institute; Outcome; Outcomes and Health Services Research; Patient observation; Patients; Pattern; Physicians; Positioning Attribute; Prevention; Procedures; Provider; Reporting; Research; Research Methodology; Risk; Risk Factors; Sampling; Sepsis; Solid; Stroke; Survivors; Syndrome; Systemic infection; Training; Variant; Writing; base; career; career development; clinically relevant; cohort; comparative effectiveness; comparative efficacy; compare effectiveness; cost effectiveness; data management; demographics; effectiveness research; efficacy trial; evidence base; heart rhythm; hemodynamics; improved; innovation; medical specialties; middle age; outcome forecast; programs; public health relevance; risk benefit ratio; sex; skills; skills training; sobriety; technique development; treatment strategy

DESCRIPTION (provided by applicant): Sepsis is a syndrome of infection and systemic inflammation that is a top 10 cause of death with increasing incidence affecting approximately 2 million Americans yearly. The inflammatory, hemodynamic, and metabolic abnormalities that characterize sepsis are also known triggers and risk factors for atrial fibrillation. Atrial fibrilation is a heart rhythm disturbance characterized by a loss of normal atrial contractility and rapid heart rates. The hypothesis that sepsis is a strong atrial fibrillation trigger is supported by the observation that patients hospitalized with severe sepsis (vs. non-severe sepsis) have a 6-fold increased risk of developing new-onset atrial fibrillation. Importantly, patients who develop new-onset AF during severe sepsis have significantly increased risk for in-hospital death and stroke. More than 1/2 of patients who develop atrial fibrillation during severe sepsis do not survive to hospital discharge. No data are available for prognostication of long term outcomes in patients with sepsis-associated, new-onset atrial fibrillation. Further, little evidence exists to weigh riss and benefits of complicated treatment decisions for atrial fibrillation during sepsis. In line with the National Heart, Lung, and Blood Institute's mission to promote the prevention and treatment of heart, lung, and blood disease, the current proposal will use complementary administrative claims data sources to determine long-term outcomes and compare effectiveness of practice patterns associated with new-onset atrial fibrillation occurring during sepsis. Through the Mentored Career Development Award, the candidate will develop skills necessary for transition to an independent research career, including training in advanced epidemiologic methods, health services/outcomes/observational comparative effectiveness research methods, advanced biostatistics/data management techniques, and development of leadership and writing expertise. The information produced from the proposed project will inform further comparative effectiveness and efficacy trials designed to directly inform clinical decisions for patients with atrial fibrillation during sepsis. In addition, the career development and training skills learned during the award will allow the candidate to build and expand upon the currently limited data sources available for the study of patients with sepsis.

描述（由申请人提供）：败血症是一种感染和全身性炎症综合征，是十大死亡原因，每年发病率增加，每年都会影响约200万美国人。表征败血症的炎症，血液动力学和代谢异常也是心房颤动的已知触发因素和危险因素。心房纤维化是一种心律障碍，其特征是丧失正常的心房收缩性和快速心率。败血症是强大的房颤触发的假设，由 观察到患有严重败血症（与非重生败血症）住院的患者患有新发颤振的风险增加了6倍。重要的是，在严重败血症中发展新发育的患者的患者大大增加了院内死亡和中风的风险。在严重败血症期间出现心房颤动的患者中，超过1/2的患者无法生存到医院出院。没有数据可用于预测与败血症相关的，新的心房颤动患者的长期结局。此外，几乎没有证据表明在败血症期间称重RISS和对心房颤动的复杂治疗决策的好处。与 国家心脏，肺部和血液研究所促进预防和治疗心脏，肺和血液疾病的使命，当前的提案将使用互补的行政索赔数据来源来确定长期结果并比较与新的诊断期间发生与新术相关的练习模式相关的实践模式的有效性。通过指导的职业发展奖，候选人将开发到过渡到独立研究职业所必需的技能，包括培训高级流行病学方法，卫生服务/结果/观察性比较有效性研究方法，高级生物统计学/数据管理技术以及领导力和写作专业知识的发展。拟议项目中产生的信息将为进一步的比较有效性和功效试验提供信息，旨在直接为败血症期间心房颤动的患者提供临床决策。此外，在奖励期间学到的职业发展和培训技巧将使候选人能够建立和扩展目前有限的数据来源，可用于研究败血症患者。