Individualizing Anticoagulant use in Older Adults with Atrial Fibrillation

患有房颤的老年人个体化抗凝药物的使用

• 批准号: 10669490
• 负责人: Sachin J Shah
• 金额: $ 24.3万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669490
• 关键词: Activities of Daily Living; Address; Adverse event; Aging; Anticoagulant therapy; Anticoagulants; Atrial Fibrillation; Award; Benefits and Risks; California; Cardiovascular system; Clinical; Clinical Trials; Complement; Conflict (Psychology); Cryosurgery; Data; Data Collection; Decision Aid; Decision Making; Decision Modeling; Dependence; Development; Devices; Disease; Elderly; Enrollment; Epidemiologic Methods; Epidemiology; Event; Foundations; Future; Goals; Grant; Guidelines; Health; Health and Retirement Study; Heart Atrium; Hemorrhage; Heterogeneity; Hospitalization; Hospitals; Impairment; Individual; Internal Medicine; Intervention; Ischemic Stroke; K-Series Research Career Programs; Lead; Left; Life Expectancy; Measures; Medicine; Mentors; Mentorship; Methods; Modeling; Modernization; Outcome; Patients; Physicians; Placebo Control; Population; Procedures; Prospective cohort; Recommendation; Recovery of Function; Reporting; Research; Research Personnel; Research Training; Risk; San Francisco; Series; Specific qualifier value; Stream; Stroke; Stroke prevention; Syndrome; Testing; Therapeutic; Training; Universities; Validation; Voice; Work; barrier to care; base; career development; clinical epidemiology; clinical practice; cohort; data resource; design; disability; experience; falls; follow-up; forest; frailty; functional outcomes; functional status; heart rhythm; high risk; human centered design; improved; individualized medicine; investigator training; leadership development; machine learning method; machine learning model; multidisciplinary; novel; outcome prediction; professor; programs; side effect; stroke risk; tool; treatment effect; trend

Project Summary/Abstract This is a Beeson (K76) career development award for Sachin J Shah, MD, MPH, a physician-investigator trained in internal medicine, clinical epidemiology, and aging research. Dr. Shah is an Assistant Professor in the Division of Hospital Medicine at the University of California, San Francisco. Dr. Shah's long-term goal is to build evidence to individualize treatment recommendations for older adults facing high-risk, high-benefit therapeutic decisions using new epidemiologic methods and geriatric research principles. The decision to use anticoagulants in older adults with atrial fibrillation (AF) is the paradigm of a high-stakes therapeutic decision because while anticoagulants prevent stroke, they increase the risk of bleeding complications. Guidelines use a one-size-fits-all approach; for older adults, they recommend near-universal anticoagulant use. In numerous studies of clinical practice, physicians report concern with the current approach voicing the need to individualize treatment recommendations for older adults. This proposal addresses the pressing need to individualize anticoagulant treatment decisions in older adults with AF through two aims. Aim 1: Develop and validate individualized estimates of the treatment effect of anticoagulants for ischemic stroke prevention in older adults with AF. This aim will use clinical trial and observational data to develop and validate a treatment effect model that will estimate individual-level treatment benefit. Aim 2: Ascertain functional outcomes after major extracranial hemorrhage, both short-term and longer-term. The functional outcomes following major hemorrhage, a key adverse event of anticoagulant therapy, are unclear, especially in older adults. Through two studies, this proposal will determine the short- and long-term functional outcomes following major hemorrhage. Dr. Shah's exceptional, multidisciplinary mentoring team is led by Dr. Margaret Fang, nationally recognized for her work studying the clinical outcomes of anticoagulants in older adults and co-mentored by Dr. Kenneth Covinsky, whose nationally recognized research program has advanced our understanding of the predictors and outcomes of disability in older adults. This career development award will support Dr. Shah's transition to research independence through mentorship and focused training in (1) measuring heterogeneous treatment effects using novel epidemiologic tools, (2) primary data collection to build prospective cohorts of older adults, (3) designing decision aids and (4) leadership development to lead cross-disciplinary, multi-institutional research teams. This proposal will support a development grant to design and pilot a clinical decision tool for older adults considering anticoagulant and a project grant to measure heterogeneous treatment effects of procedural interventions in older adults with AF. The proposed research and training aims will provide Dr. Shah with the data, training, and experience to support competitive R-series applications.

项目摘要/摘要 这是Beeson（K76）的职业发展奖，医学博士Sachin J Shah，医师评估员MPH 接受过内科，临床流行病学和衰老研究的培训。 Shah博士是一位助理教授 加利福尼亚大学旧金山分校医院医学司。沙阿博士的长期目标是 为面对高风险，高收益的老年人提供个性化治疗建议的证据 使用新的流行病学方法和老年研究原则的治疗决定。使用的决定 心房颤动（AF）的老年人的抗凝剂是高风险治疗决定的范式 因为尽管抗凝剂阻止中风，但它们增加了出血并发症的风险。指南使用 一件大小的方法；对于老年人，他们建议使用近乎全世界的抗凝剂。在很多 临床实践的研究，医生报告了对当前方法的关注，表达了需要 针对老年人的个性化治疗建议。该提议解决了紧迫的需求 通过两个目标，在患有AF的老年人中个性化抗凝治疗决策。目标1：发展和 验证抗凝药预防缺血性中风的治疗效果的个性化估计值 AF的老年人。该目标将使用临床试验和观察数据来开发和验证治疗 效应模型将估计个人级治疗益处。目标2：确定功能结果之后 短期和长期的主要颅外出血。大调的功能结果 出血是抗凝治疗的关键不良事件，尚不清楚，尤其是在老年人中。通过两个 研究，该提案将确定重大出血后的短期和长期功能结果。 Shah博士的杰出，多学科指导团队由玛格丽特·法博士（Margaret Fang）领导，他在全国认可 为了研究老年人抗凝剂的临床结果，并由肯尼斯博士合作 科文斯基（Covinsky）的全国认可的研究计划提高了我们对预测因素的理解 和老年人残疾的结果。该职业发展奖将支持Shah博士向 通过指导和重点培训在（1）测量异质治疗中研究独立性 使用新型流行病学工具的效果，（2）主要数据收集以建立老年人的前瞻性人群， （3）设计决策辅助工具和（4）领导跨学科，多机构的发展 研究团队。该提案将支持设计和驾驶临床决策工具的发展赠款 考虑抗凝剂和项目赠款的老年人，以衡量 AF的老年人的程序干预措施。拟议的研究和培训目标将为Shah博士提供。 借助数据，培训和经验，以支持竞争性的R系列应用程序。