Optimizing Treatment of Older Adults with Hypertension: A Net Benefit Analysis of Falls Injury vs Cardiovascular Outcomes

优化老年高血压患者的治疗：跌倒损伤与心血管结果的净效益分析

• 批准号: 9250056
• 负责人: Lillian Chiang Min
• 金额: $ 32.88万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9250056
• 关键词: Acute; Adherence; Adult; Affect; Age; Ambulatory Care; American; Benefits and Risks; Blood Pressure; Cardiac; Cardiovascular system; Caring; Cessation of life; Characteristics; Chronic; Clinical; Clinical Treatment; Comorbidity; Data; Data Set; Databases; Diabetes Mellitus; Disputes; Elderly; Electronic Health Record; Event; Fall injury; Fright; Future; Goals; Guidelines; Health; Health Status; Health and Retirement Study; Health system; Healthcare; Healthcare Systems; Heart failure; Hip Fractures; Hypertension; Hypotension; Individual; Injury; Interview; Joints; Link; Long-Term Care; Measures; Medical; Medicare; Medicare claim; Methods; Modeling; Myocardial Infarction; Outcome; Patients; Performance; Pharmaceutical Preparations; Population; Prevalence; Public Health; Recommendation; Reporting; Research; Risk; Risk Reduction; Severities; Statistical Methods; Stroke; Taxonomy; Testing; Variant; Veterans; Work; adverse outcome; aggressive therapy; arm; blood pressure reduction; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; common treatment; control trial; cost; disorder risk; epidemiology study; fall risk; falls; functional decline; health administration; hypertension control; improved; innovation; older patient; patient oriented; patient population; population survey; prevent; public health relevance; young adult

 DESCRIPTION (provided by applicant): Every year, one in 10 older people fall and sustain injury requiring medical care. Fall-related injury is the number one cause of accidental death in older Americans. However, fall injury is rarely considered as a outcome in controlled trials, which have traditionally focused on death and cardiovascular events. Until recently, we lacked methods of capturing fall-related injury in large healthcare databases. We will first use the Health and Retirement Study, a national study of older Americans, to develop a method of classifying severe fall injury in found in Medicare claims data across acute, ambulatory, and long-term care (Aim 1). Next, we will study how a national healthcare system, the Veterans Health Administration (VHA), delivers aggressive hypertension care (AHC) and whether AHC results in net benefit or harm due to cardiovascular events and severe fall-related injury. Hypertension is the single most common chronic condition in older adults. Medication treatment prevents important cardiovascular events (strokes, myocardial infarctions and heart failure), however also contributes to risk of falls. We do not fully understand the net benefits and harms among our oldest patients in clinical practice, especially after age 75 - those most prone to severe fall-injury. Thus, we aim to study the net harms and benefits associated with AHC, defined as low blood pressure (BP, <130/65 mmHg) and prescribed =3 BP medications. We have demonstrated that the VHA, a national leader in hypertension care, has used performance measures to improve care but increased rates of AHC - especially among older Veterans. The average BP for those with AHC was 114/58 mmHg - lower than the aggressive treatment arm in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. A study that captures AHC, achieved BP, and falls injury is needed. Such a study is not possible anywhere except in the VHA. In the VHA, we have carefully used sophisticated electronic databases to identify the older patients with AHC. We will study whether certain types of VHA facilities are more likely to deliver AHC to their older patients (Aim 2), then test whether AHC increases short-term risk of injurious falls (Aim 3A). Last, we will compare whether net harm results from AHC when considering both severe fall-related injury and cardiovascular events (Aim 3B). This research will inform which patients and facilities should be targeted for future efforts to reduce AHC. Innovation. This research includes innovative methods of using claims data across acute, ambulatory, and long term care data and cutting-edge statistical methods of modeling multiple outcomes to determine whether the harm of AHC outweighs the benefit of cardiovascular event reduction. Impact. Optimizing risks and benefits of approaches to hypertensive care is patient-centered and has implications for the broader health and care of older adults. At the patient level, health care information about low benefit and potential harm is critical to make informed decisions. At the population level, improved methods of optimizing treatment targets can apply to broader clinical tradeoffs in older patient populations.

 描述（由适用提供）：每年，十分之一的老年人跌倒并维持需要医疗的伤害。与跌倒有关的伤害是老年人意外死亡的第一大原因。但是，在对照试验中，很少将秋季伤害视为结果，这些试验传统上关注死亡和心血管事件。直到最近，我们还没有在大型医疗保健数据库中捕获与跌倒有关的伤害的方法。我们将首先使用对年龄较大的美国人的全国性研究健康和退休研究，以开发一种对急性，卧床和长期护理的Medicare索赔数据中发现的严重跌倒损伤的方法（AIM 1）。接下来，我们将研究国家医疗保健系统，退伍军人健康管理局（VHA），积极的高血压护理（AHC）以及AHC是否会因心血管事件和严重跌倒有关的伤害而造成净收益或伤害。高血压是老年人中最常见的慢性病。药物治疗可阻止重要的心血管事件（中风，心肌违规和心力衰竭），但也有助于跌倒的风险。我们在临床实践中，尤其是75岁之后，我们最老的患者中最老的患者的净益处和危害不完全理解，这些患者最容易受到严重伤害。这是我们旨在研究与AHC相关的净危害和益处，定义为低血压（BP，<130/65 mmHg），并处方= 3 bp药物。我们已经证明，VHA是高血压护理领域的国家领导者，他采取了绩效指标来改善护理，但AHC的比率提高，尤其是在老年退伍军人中。患有AHC患者的平均BP为114/58 mmHg-比控制糖尿病（ACCORC）试验的心血管风险的侵略性治疗组低。需要一项捕获AHC，达到BP和跌倒受伤的研究。除VHA外，除了任何地方都无法进行此类研究。在VHA中，我们精心使用了复杂的电子数据库来识别老年AHC患者。我们将研究某些类型的VHA设施是否更有可能向其老年患者提供AHC（AIM 2），然后测试AHC是否增加了有害跌倒的短期风险（AIM 3A）。最后，我们将比较AHC在考虑严重跌倒相关伤害和心血管事件时是否造成净伤害（AIM 3B）。这项研究将告知哪些患者和设施应成为未来减少AHC的努力的目标。创新。这项研究包括在急性，卧床和长期护理数据中使用索赔数据的创新方法，以及对多种结果进行建模以确定AHC的危害是否超过心血管事件减少的益处的尖端统计方法。影响。优化高血压护理方法的风险和好处是以患者为中心的，对更广泛的老年人健康和护理具有影响。在患者一级，有关低福利和潜在伤害的医疗保健信息对于做出明智的决定至关重要。在人群一级，改进的优化治疗目标的方法可以适用于老年患者人群的更广泛的临床折衷。