A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy

射血分数保留 (HFpEF) 心力衰竭的新型处方干预措施：针对患有多种疾病和多药治疗的老年人的原型

• 批准号: 10673696
• 负责人: PARAG GOYAL
• 金额: $ 22.27万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673696
• 关键词: Address; Adrenergic beta-Antagonists; Adverse event; Affect; Aging; American; Area; Attention; Belief; Benefits and Risks; Biological; Biometry; Cardiac Output; Cardiology; Caring; Clinical Trials; Communication; Complex; Crossover Design; Data; Decision Making; Development; Drug Prescriptions; EFRAC; Effectiveness; Elderly; Ensure; Environment; Event; Experimental Designs; Foundations; Funding; Future; Geriatrics; Goals; Grant; Health; Health Priorities; Heart; Heart failure; Impairment; Individual; Intervention; Knowledge; Knowledge acquisition; Lead; Left; Life Expectancy; Manuscripts; Medication Management; Medicine; Mentors; Mentorship; Office Visits; Outcome; Participant; Patient Outcomes Assessments; Patients; Personal Satisfaction; Pharmaceutical Preparations; Polypharmacy; Population; Population Study; Positioning Attribute; Precision therapeutics; Principal Investigator; Process; Protocols documentation; Randomized, Controlled Trials; Research Personnel; Research Project Grants; Role; Signal Transduction; Syndrome; Testing; Time; Training; Uncertainty; United States; Variant; Ventricular; aging population; career; career development; clinical practice; college; drug withdrawal; effectiveness-implementation RCT; effectiveness/implementation hybrid; effectiveness/implementation trial; experience; hospitalization rates; implementation science; improved; improved outcome; individual patient; innovation; iterative design; mortality; multiple chronic conditions; novel; patient oriented; preference; preservation; prevent; programs; prototype; shared decision making; skills; success; supportive environment; theories; working group

PROJECT SUMMARY Candidate: My career goal is to improve the wellbeing of older adults with multiple chronic conditions and polypharmacy by developing and rigorously testing rational strategies to improve medication prescribing practices; and to become an independent clinician investigator and national leader in Geriatric Cardiology. This area is particularly relevant for me as a heart failure cardiologist, as I care for older adults who almost universally have multiple chronic conditions and polypharmacy. My track record as an emerging leader in this area is evidenced by multiple lead- and senior-author manuscripts, 4 grants as the Principal Investigator including a GEMSSTAR, my position as the Founding Director of the Weill Cornell Heart Failure with Preserved Ejection (HFpEF) Program for the Aging, and my role as the Chair of the American College of Cardiology Geriatric Cardiology Section Early Career Professionals Working Group. Mentors and Environment: This project will be conducted under the mentorship of 4 well-funded investigators who will contribute their complementary expertise in Geriatrics (Mark Lachs), Geriatric Cardiology (Mathew Maurer), Implementation Science (Monika Safford), and N-of-1 trials (Ian Kronish). Advisors in deprescribing, shared decision making, and biostatistics will provide additional content expertise to ensure the success of the proposed project and catalyze my career development. This project will take place within the supportive environment of Weill Cornell Medicine, which has demonstrated a deep commitment to my development as a clinician-investigator for the past several years. Mentored Research Project: Despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is seldom incorporated into clinical practice due to several barriers. To improve patient-centered medication management, there is a need to develop processes that can overcome these barriers. The objective of this proposal is to determine whether N- of-1 trials—as a pragmatic patient-centered approach to medication optimization that can overcome key barriers of deprescribing— can lead to increased patient confidence regarding the decision to continue or discontinue a medication. To achieve this, I will: 1) determine key features of a feasible and pragmatic protocol for deprescribing N-of-1 trials using a stakeholder-engaged iterative design approach; and 2) determine the preliminary effectiveness of an adapted N-of-1 protocol on patient decision confidence and deprescribing, and 3) determine the facilitators and barriers of implementing an adapted N-of-1 protocol into real-world clinical practice by conducting a type-1 hybrid effectiveness-implementation trial. I will achieve these aims by using ß- blocker in heart failure with preserved ejection fraction (HFpEF) as a prototype for older adults with multimorbidity and polypharmacy. This proposal will inform a future multicenter randomized controlled trial focused on improving patient-reported outcomes, and provide a formative opportunity for me to obtain the knowledge and skills necessary to become a leading researcher on patient-centered medication management.

项目概要 候选人：我的职业目标是改善患有多种慢性病的老年人的福祉 通过制定和严格测试合理策略来改善药物处方的多药治疗 实践；并成为老年心脏病学的独立临床研究者和国家领导者。 作为一名心力衰竭心脏病专家，该领域对我来说特别重要，因为我照顾的老年人几乎 我作为这方面的新兴领导者，普遍患有多种慢性病和多药治疗。 该领域由多篇主要作者和资深作者手稿证明，作为首席研究员获得 4 项资助 包括 GEMSSTAR，我作为威尔康奈尔心力衰竭中心的创始董事 老年保留射血 (HFpEF) 计划，以及我作为美国老年学院主席的角色 心脏病学老年心脏病学科早期职业专业人员工作组。 该项目将在 4 名资金充足的研究人员的指导下进行，他们将贡献自己的力量 老年病学（Mark Lachs）、老年心脏病学（Mathew Maurer）的补充专业知识， 实施科学（Monika Safford）和 N-of-1 试验（Ian Kronish）在取消处方方面共享。 决策和生物统计学将提供额外的内容专业知识，以确保项目的成功 拟议的项目并促进我的职业发展 该项目将在支持范围内进行。 威尔康奈尔医学的环境，这表明了对我作为一名医生的发展的坚定承诺 过去几年的临床医生研究员指导研究项目：尽管它是一个不可或缺的组成部分。 在以患者为中心和目标一致的处方实践中，取消处方很少被纳入临床 由于存在一些障碍，为了改善以患者为中心的药物管理，有必要进行实践。 制定能够克服这些障碍的流程。本提案的目标是确定 N- 是否有效。 of-1 试验——作为一种以患者为中心的实用药物优化方法，可以克服关键问题 取消处方的障碍——可以增强患者对继续或继续用药决定的信心 为了实现这一目标，我将：1）确定可行且务实的方案的关键特征。 使用利益相关者参与的迭代设计方法取消 N-of-1 试验；以及 2) 确定 调整后的 N-of-1 方案对患者决策信心和处方减少的初步有效性，以及 3) 确定将改编后的 N-of-1 方案实施到现实临床中的促进因素和障碍 通过进行 1 型混合有效性实施试验来进行实践，我将通过使用 ß- 来实现这些目标。 以射血分数保留型心力衰竭 (HFpEF) 为原型的阻滞剂，用于患有老年痴呆症的老年人 该提案将为未来的多中心随机对照试验提供信息。 专注于改善患者报告的结果，并为我提供了获得 成为以患者为中心的药物管理领域的领先研究人员所需的知识和技能。

项目成果

Association of Perceived Stress With Incident Heart Failure.

• DOI: 10.1016/j.cardfail.2022.04.013
• 发表时间: 2022-09
• 期刊: Journal of cardiac failure
• 影响因子: 6

Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19.

• DOI: 10.1161/circheartfailure.121.008354
• 发表时间: 2021-09
• 期刊: Circulation. Heart failure
• 作者: Goyal P;Reshetnyak E;Khan S;Musse M;Navi BB;Kim J;Allen LA;Banerjee S;Elkind MSV;Shah SJ;Yancy C;Michos ED;Devereux RB;Okin PM;Weinsaft JW;Safford MM
• 通讯作者: Safford MM

Geriatric Domains in Patients with Heart Failure with Preserved Ejection Fraction.

• DOI: 10.1016/j.ccl.2022.06.006
• 发表时间: 2022-11
• 期刊: CARDIOLOGY CLINICS
• 影响因子: 2.4
• 作者: Goyal, Parag;Zainul, Omar;Marshall, Dylan;Kitzman, Dalane W.
• 通讯作者: Kitzman, Dalane W.

Prevalence of Potentially Inappropriate Medication Prescribing in US Nursing Homes, 2013-2017.

2013-2017 年美国疗养院中潜在不适当药物处方的发生率。

• DOI: 10.1007/s11606-022-07825-6
• 发表时间: 2023
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Riester,MelissaR;Goyal,Parag;Steinman,MichaelA;Zhang,Yuan;Rodriguez,MarielaF;Paul,DakotaRome;Zullo,AndrewR
• 通讯作者: Zullo,AndrewR

N-of-1 Trials for Pediatric Hypertension? A Promising Approach to Increasing the Precision of Antihypertensive Treatment.

小儿高血压的 N-of-1 试验？

• DOI: 10.1093/ajh/hpac125
• 发表时间: 2023
• 期刊: American journal of hypertension
• 影响因子: 3.2
• 作者: Goyal,Parag;Kronish,IanM
• 通讯作者: Kronish,IanM