Pathways to cardiovascular disease prevention and impact of specialty referral in under-represented racial/ethnic minorities with HIV

心血管疾病预防途径以及专科转诊对代表性不足的艾滋病毒感染者种族/族裔的影响

• 批准号: 9884558
• 负责人: Gerald Samuel Bloomfield
• 金额: $ 69.94万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884558
• 关键词: Accounting; Address; Affect; African American; Atherosclerosis; Blood Pressure; Cardiac; Cardiac health; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Cholesterol; Clinic Visits; Clinical; Clinical Data; Coronary heart disease; Counseling; Data; Death Rate; Development; Disease Outcome; Effectiveness; Electronic Health Record; Event; Face; Female; Future; Goals; Guidelines; HIV; HIV Infections; Health; Health Insurance; Health system; Heart failure; Hospitalization; Individual; Institution; Intervention; Interview; Knowledge; Lead; Measures; Medical; Medication Management; Mission; Modeling; Myocardial Infarction; Not Hispanic or Latino; Outcome; Outcome Measure; Pathway interactions; Patients; Population; Predictive Factor; Prevention Measures; Primary Prevention; Provider; Public Health; Race; Research; Risk; Risk Management; Sampling; Scientific Inquiry; Specialist; Stroke; Structure; System; Testing; Tobacco Use Cessation; Transportation; Treatment outcome; Trust; United States National Institutes of Health; Visit; Work; base; blood lipid; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; care coordination; clinical care; cohort; comorbidity; contextual factors; cost; data modeling; design; electronic data; ethnic diversity; ethnic minority population; evidence based guidelines; follow-up; glycemic control; health care disparity; health disparity; improved; informant; innovation; medical specialties; meetings; minority health; prevent; primary outcome; racial and ethnic; secondary outcome; social stigma; treatment effect

There is an urgent need to determine pathways to cardiovascular disease (CVD) prevention for under- represented racial/ethnic minorities with HIV and elevated cardiovascular risk. Such evidence will ultimately inform clinical care guidelines and health system interventions to improve health for health disparity populations with HIV. Thus, the long-term goal of this proposal is to generate evidence-based recommendations for the management of CVD risk in PLWH. The overall objectives of this application are to demonstrate the effect of cardiology referral on CVD health outcomes in a large racially/ethnically diverse cohort of people living with HIV (PLWH), and to generate qualitative and quantitative evidence to guide development of a future intervention. Our central hypothesis is that cardiology referral reduces incident CVD events in Blacks/African-Americans and other racial/ethnic minorities with HIV compared to non-referral. The rationale for our research is that, once it is known how these health disparity populations with HIV access cardiology referrals and the subsequent impact on CVD outcomes, an interventional can be appropriately designed to test new and innovative approaches to the management of co-morbidities for PLWH at elevated CVD risk. We plan to test our central hypothesis and thereby accomplish our overall objectives by pursuing the following three specific aims: (Aim 1) To measure the association between cardiology referral and CVD outcomes in under-represented racial/ethnic minorities with HIV, (Aim 2) To identify the individual- and health system-level factors that impact CVD outcomes for under-represented racial/ethnic minorities, and (Aim 3) To develop a qualitative framework for an intervention to improve CVD outcomes in PLWH. We will retrospectively analyze patient-level data from electronic health records from institutions in the U.S. Southeast “HIV-belt” and “Heart Attack belt”, using PCORnet’s Common Data Model. We will retrospectively identify cohorts of African- American and other under-represented racial/ethnic minorities and non-Hispanic white patients with HIV. Start date will be first clinical contact after January 1, 2010 to create a contemporary cohort with at least 5 years of longitudinal follow-up. The main independent variable is a clinic visit with a cardiologist, compared to not having such a visit, prior to first CVD event. Our primary outcome is myocardial infarction, hospitalization for heart failure, stroke, coronary heart disease, death or cardiovascular death after 5 years. Our scientific contribution is expected to be significant because we are addressing a dire health comorbidity for PLWH. Our group’s efforts are likely to contribute to greater understanding of how HIV-related CVD effects treatment outcomes among under-represented racial/ethnic minorities with HIV. As a consequence of the work proposed, we expect to identify the underlying pathways to ideal CVD care for under-represented racial/ethnic minorities with HIV. We anticipate results that lead to better integration and coordination of care and ultimately improve CVD health outcomes for health disparity populations with HIV.

迫切需要确定心血管疾病（CVD）预防途径 这些证据最终将代表感染艾滋病毒和心血管风险较高的种族/族裔。 为临床护理指南和卫生系统干预措施提供信息，以改善健康状况，消除健康差距 因此，该提案的长期目标是产生基于证据的证据。 PLWH CVD 风险管理的建议 本应用的总体目标是 证明心脏病学转诊对不同种族/民族的 CVD 健康结果的影响 艾滋病毒感染者 (PLWH) 群体，并生成定性和定量证据来指导 我们的中心假设是心脏病转诊可减少 CVD。 与未转诊相比，黑人/非裔美国人和其他少数种族/族裔感染艾滋病毒的事件。 我们研究的基本原理是，一旦了解这些健康差异人群如何获得艾滋病毒 心脏病转诊以及随后对 CVD 结果的影响，可以适当进行介入治疗 旨在测试治疗高危人群 PLWH 合并症的创新方法 我们计划检验我们的中心假设，从而通过追求以下目标来实现我们的总体目标： 以下三个具体目标：（目标 1）衡量心脏病转诊与 CVD 之间的关联 感染艾滋病毒的少数种族/族裔的结果，（目标 2）确定个人和健康状况 影响代表性不足的少数种族/族裔的 CVD 结果的系统层面因素，以及（目标 3） 我们将回顾性地制定一个干预措施的定性框架，以改善 PLWH 的 CVD 结局。 分析美国东南部“艾滋病毒带”机构的电子健康记录中的患者级别数据， “心脏病带”，使用 PCORnet 的通用数据模型 我们将回顾性地识别非洲人群。 美国和其他代表性不足的种族/族裔以及非西班牙裔白人艾滋病毒患者开始。 日期将在 2010 年 1 月 1 日之后进行首次临床接触，以创建至少 5 年的当代队列 主要自变量是与心脏病专家的临床随访相比。 在第一次 CVD 事件之前进行此类检查，我们的主要结果是心肌梗塞、住院治疗。 5年后心力衰竭、中风、冠心病、死亡或心血管死亡。 预计贡献将是巨大的，因为我们正在解决 PLWH 的可怕的健康合并症问题。 该小组的努力可能有助于更好地了解艾滋病毒相关的心血管疾病如何影响治疗 代表性不足的艾滋病毒感染者的结果 作为所提议的工作的结果， 我们期望为代表性不足的种族/族裔确定理想的 CVD 护理的基本途径 我们期望能够更好地整合和协调护理并最终改善治疗效果。 HIV 感染者健康差异人群的 CVD 健康结果。