Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients

老年心力衰竭患者的多重发病率和治疗相关结果

• 批准号: 10425366
• 负责人: Mayra S. Tisminetzky
• 金额: $ 47.42万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10425366
• 关键词: Address; Adrenergic beta-Antagonists; Adult; Affect; Age-Years; Aging; Anemia; Angiotensin II Receptor; Angiotensin-Converting Enzyme Inhibitors; Bradycardia; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Clinical; Clinical Management; Clinical Practice Guideline; Clinical Trials; Clinical effectiveness; Communities; Data; Data Set; Decision Making; Diabetes Mellitus; Disease; Diuretics; Effectiveness; Elderly; Electronic Health Record; Fasting; Geography; Goals; Grant; Health Status; Heart failure; Heterogeneity; Hospitalization; Individual; Investigation; Knowledge; Left Ventricular Ejection Fraction; Lung diseases; Medical; Methods; Mineralocorticoid Receptor; Morbidity - disease rate; National Institute on Aging; Natural Language Processing; Older Population; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Quality of Care; Renin-Angiotensin-Aldosterone System; Research; Risk; Safety; Sodium; Syncope; Syndrome; System; Technology; Therapeutic; Treatment Failure; United States Dept. of Health and Human Services; adverse outcome; base; cohort; common treatment; comorbidity; effectiveness evaluation; follow-up; health care delivery; high risk; hyperkalemia; improved; insight; kidney dysfunction; mortality risk; multiple chronic conditions; novel; patient subsets; population based; practice setting; preservation; randomized trial; response; unstructured data; Address; Adrenergic beta-Antagonists; Adult; Affect; Age-Years; Aging; Anemia; Angiotensin II Receptor; Angiotensin-Converting Enzyme Inhibitors; Bradycardia; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Clinical; Clinical Management; Clinical Practice Guideline; Clinical Trials; Clinical effectiveness; Communities; Data; Data Set; Decision Making; Diabetes Mellitus; Disease; Diuretics; Effectiveness; Elderly; Electronic Health Record; Fasting; Geography; Goals; Grant; Health Status; Heart failure; Heterogeneity; Hospitalization; Individual; Investigation; Knowledge; Left Ventricular Ejection Fraction; Lung diseases; Medical; Methods; Mineralocorticoid Receptor; Morbidity - disease rate; National Institute on Aging; Natural Language Processing; Older Population; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Quality of Care; Renin-Angiotensin-Aldosterone System; Research; Risk; Safety; Sodium; Syncope; Syndrome; System; Technology; Therapeutic; Treatment Failure; United States Dept. of Health and Human Services; adverse outcome; base; cohort; common treatment; comorbidity; effectiveness evaluation; follow-up; health care delivery; high risk; hyperkalemia; improved; insight; kidney dysfunction; mortality risk; multiple chronic conditions; novel; patient subsets; population based; practice setting; preservation; randomized trial; response; unstructured data

PROJECT SUMMARY/ABSTRACT Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, typically defined as the presence of ≥2 chronic conditions, increases the risks of hospitalization and death in older HF patients, and greatly complicates the clinical management of HF. Caution is required in applying national clinical practice guidelines to the care of older adults with multimorbidity, as this could result in undesirable net effects and less than optimal outcomes including adverse interactions between drugs and various concomitant diseases. In response to PA-17-088 (Exploratory Analyses of Existing Cohorts, Data Sets, and Stored Biospecimens to Address Clinical Aging Research Questions, R01), we propose to leverage an existing HF cohort, including data for more than 100,000 patients with HF within the Cardiovascular Research Network between 2005-2012, with follow-up data up to 2017. We will extend our previous efforts by examining treatment patterns and the net benefits versus harms of selected therapies in older adults with HF and a wide spectrum of multimorbidity burden. We will further examine the benefits and adverse outcomes of various therapies focusing on particularly vulnerable subgroups of patients with HF afflicted by two prevalent conditions, anemia or diabetes. Our specific aims are: (1) to examine the effectiveness of selected medical therapies (renin-angiotensin- aldosterone system blockers, beta-blockers, diuretics, and aldosterone receptor blockers) on death, HF hospitalization, and all-cause hospitalizations in a large, community-based population of older adults with HF across a range of levels of multimorbidity burden and left ventricular ejection fraction; (2) to evaluate targeted adverse outcomes, including kidney dysfunction, hyperkalemia, sodium disturbances, bradycardia, and syncope associated with selected HF therapies in older adults with HF, stratified by multimorbidity burden and left ventricular ejection fraction status; and (3) to characterize the potential benefits and adverse outcomes associated with selected HF therapies in older adults with HF and two prevalent comorbidity dyads—HF- diabetes and HF-anemia—that are common and substantially increase the risks of death and morbidity. In addition, we will create novel, validated methods to identify adverse outcomes related to HF therapies from unstructured data in large electronic health record systems through natural language processing technology, along with employing state-of-the-art analytic approaches to evaluate treatment-related outcomes. In that our proposed investigation will take advantage of a large, geographically and demographically diverse cohort of adults with HF receiving care within community-based healthcare delivery systems, we anticipate our findings will be highly generalizable to the broad spectrum of older adults with HF managed in “real-world” practice settings.

项目摘要/摘要 心力衰竭（HF）是老年人住院的最常见原因。超过85％的患者 HF住院的年龄65岁或以上。多发性疾病，通常定义为≥2的存在 慢性病，增加HF患者的住院风险和死亡的风险，并且大大增加 使HF的临床管理复杂化。应用国家临床实践指南需要谨慎 照顾多发病的老年人，因为这可能会导致不良的净效应，而小于 最佳结果，包括药物与各种伴随疾病之间的不良相互作用。在 对PA-17-088的响应（对现有队列，数据集和存储生物测量的探索性分析 解决临床老化研究问题，R01），我们建议利用现有的HF队列，包括 2005 - 2012年间，心血管研究网络中有100,000多名HF患者的数据， 随着后续数据至2017年。我们将通过检查治疗模式和网络来扩大以前的努力 HF老年人和多种多发病的老年人中所选疗法的益处与危害 负担。我们将进一步研究各种疗法的好处和不利结果 尤其是患有两种普遍疾病，贫血或糖尿病患者的HF患者的脆弱亚组。 我们的具体目的是：（1）检查选定的医疗疗法的有效性（肾素 - 血管紧张素 - 醛固酮系统阻滞剂，β受体阻滞剂，利尿剂和醛固酮受体阻滞剂）在死亡时，HF HF的大量，基于社区的老年人的住院和全因住院 在多种多发性燃烧和左心室射血分数的范围内； （2）评估目标 不良后果，包括肾功能障碍，高卡利症，钠疾病，心动过缓和 与HF的老年人中选定的HF疗法相关的晕厥，由多发病性伯恩（Burnen）和 左心室射血分数状态； （3）表征潜在的好处和不利结果 与HF和两个普遍的合并症二元组中的老年人中选定的HF疗法有关 糖尿病和HF贫血 - 很普遍，大大增加了死亡和发病率的风险。在 此外，我们还将创建新颖的，经过验证的方法，以识别与HF疗法相关的广告结果 大型电子健康记录系统中的非结构化数据通过自然语言处理技术， 同时采用最先进的分析方法来评估与治疗相关的结果。在我们的 拟议的调查将利用大型，地理和人口统计多样的队列 HF在基于社区的医疗保健提供系统中接受护理的成年人，我们预计我们的发现 在“现实世界”实践中管理HF的老年人的广泛范围将高度推广 设置。