Observational Study of Delay in Heart Failure

心力衰竭延迟的观察性研究

• 批准号: 7479692
• 负责人: ROBERT JOEL GOLDBERG
• 金额: $ 78.11万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-15 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7479692
• 关键词: Accounting; Acute; Acute myocardial infarction; Adult; Aftercare; Age; Agreement; Area; Attention; Attitude; Belief; Caring; Case Fatality Rates; Characteristics; Chronic Disease; Cities; Clinical; Communities; Congestive Heart Failure; Consent; Coronary; Coronary heart disease; Data; Decision Making; Demographic Factors; Development; Development, Other; Enrollment; Event; Exhibits; Failure; Family member; Female; Funding; Future; General Population; Health Insurance; Health Personnel; Healthcare; Healthcare Systems; Heart Diseases; Heart failure; Hospitalization; Hospitals; Hour; Incidence; Individual; Institution; Insurance Coverage; Intensive Care Units; Interview; Knowledge; Lead; Length of Stay; Life; Link; Longitudinal Studies; Lung; Medical; Medical Assistance; Medical History; Medical Records; Medical Surveillance; Morbidity - disease rate; Myocardial Reperfusion; Numbers; Observational Study; Outcome; Patients; Pattern; Physicians; Practice Management; Prevalence; Prospective Studies; Public Health; Questionnaires; Rate; Recording of previous events; Records; Recurrence; Reporting; Risk; Severities; Signs and Symptoms; Spouses; Surveys; Symptoms; Syndrome; Telephone Interviews; Time; United States National Institutes of Health; Woman; Work; abstracting; acute coronary syndrome; comparison group; day; design; follow-up; hemodynamics; improved; indexing; male; mortality; older patient; programs; prospective; response; therapy design; time interval

DESCRIPTION (provided by applicant): Prolonged delay in seeking medical care after the onset of acute coronary symptoms is associated with a reduced likelihood of successful coronary reperfusion and increased risk of adverse outcomes. These observations have prompted educational initiatives aimed at reducing delay time and reducing the risk of morbidity and mortality in patients with acute coronary disease. Associated with, and partially due to the improved management of patients with acute coronary syndromes, the prevalence of congestive heart failure (HF) in the U.S. has increased dramatically over time. Despite the fact that this clinical syndrome is characterized by acute exacerbations, surprisingly little investigative work has examined extent of delay in seeking medical care after the onset of HF related symptoms and the impact of prolonged delay on subsequent management practices and outcomes. The objectives of the proposed observational study are to prospectively evaluate extent of delay from symptom onset until hospital presentation in patients with acute HF, examine factors associated with prolonged delay, and the relation of delay times to specific hospital and post-discharge outcomes. The study will be carried out in adult male and female patients of all ages presenting with HF to 3 urban Worcester (MA) hospitals. The study objectives will be accomplished through individual patient interviews as well as through the review of medical records. A standardized survey, designed to quantify and characterize delay patterns associated with the onset of acute HF, will be administered to consenting patients. Where possible, patients' spouses will also be interviewed. We anticipate enrolling 1750 to 2100 patients with validated acute HF over a 3.5-year period. To the best of our knowledge, although data describing the magnitude of, and factors associated with, pre-hospital delay have been collected in patients with acute myocardial infarction, comparable information does not exist for patients with acute HF. If an association between prolonged delay times and increased risk of adverse outcomes can be demonstrated and characterized for patients with acute HF, this may justify broader educational initiatives aimed at the general public and their health care providers to decrease the time interval between symptom onset and seeking of medical care. Relevance: Heart failure is currently recognized as a major public health problem. This study will examine factors associated with delay in seeking medical care in patients with heart failure and the impact of delay on morbidity and mortality. These data will be useful in the development of future educational and treatment strategies designed to improve outcomes in patients with heart failure.

描述（由申请人提供）：急性冠状动脉症状发作后寻求医疗护理的长时间延迟与成功的冠状动脉再灌注的可能性降低有关，并增加了不良后果的风险。这些观察结果促使旨在减少延迟时间并降低急性冠状动脉疾病患者发病率和死亡率的风险。与急性冠状动脉综合征患者的治疗改善有关，并且部分原因是美国充血性心力衰竭（HF）的患病率随着时间的流逝而大大增加。尽管该临床综合征的特征是急性加重，但令人惊讶的是，很少有调查工作检查了HF相关症状发作后寻求医疗护理的延迟程度，以及长时间延迟对随后的管理实践和结果的影响。拟议的观察性研究的目标是前瞻性评估急性HF患者的症状延迟到医院出现的延迟程度，检查与延迟延迟有关的因素，以及将延迟时间与特定医院的关系和入院后结果的关系。这项研究将在所有年龄段的成年男性和女性患者中进行，以HF至3个城市伍斯特（MA）医院。研究目标将通过个人患者访谈以及对病历的审查来实现。一项标准化的调查，旨在量化和表征与急性HF发作相关的延迟模式，将用于同意患者。在可能的情况下，还将采访患者的配偶。我们预计将在3。5年的时间内招募1750至2100例急性HF的患者。据我们所知，尽管急性心肌梗死患者的数据描述了与院前延迟的大小和因素相关的数据，但对于急性HF患者而言，不存在可比较的信息。如果可以证明和表征急性HF患者的长时间延迟时间与增加不良后果风险之间的关联，这可能证明针对公众及其医疗保健提供者的更广泛的教育计划是合理的，以减少症状发作和寻求医疗保健之间的时间间隔。相关性：心力衰竭目前被认为是一个主要的公共卫生问题。这项研究将检查与心力衰竭患者寻求医疗护理以及延迟对发病率和死亡率的影响有关的因素。这些数据将有助于制定未来的教育和治疗策略，旨在改善心力衰竭患者的结局。