Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF)

房颤老年因素的系统评估 (SAGE-AF)

• 批准号: 9028426
• 负责人: David D. McManus
• 金额: $ 80.34万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-17 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028426
• 关键词: Adverse drug effect; Affect; Age; Aging; American; Anticoagulant therapy; Anticoagulants; Anticoagulation; Antidotes; Atrial Fibrillation; Bleeding time procedure; Client satisfaction; Clinic; Clinical; Clinical assessments; Cognition; Cognitive; Comorbidity; Complex; Decision Making; Dose; Drug Interactions; Elderly; Elements; Enrollment; Family; Future; Geriatric Assessment; Gray unit of radiation dose; Guidelines; Hemorrhage; Heterogeneity; Impaired cognition; Indium; Instruction; Interview; Knowledge; Measures; Medical Records; Mental Depression; Monitor; Observational Study; Oral; Outcome; Patients; Physicians; Physiological; Plague; Provider; Public Domains; Quality of life; Recording of previous events; Recruitment Activity; Reporting; Resources; Risk; Risk Assessment; Sampling; Social isolation; Social support; Stroke; Testing; Therapeutic; Time; Translating; Tsunami; Visit; Warfarin; Work; base; cognitive function; cohort; cost; depressive symptoms; fall risk; follow-up; frailty; functional disability; high risk; human old age (65+); improved; instrument; neglect; novel; older patient; prospective; psychosocial; public health relevance; research clinical testing; research study; satisfaction; tool; uptake; user-friendly; web site

 DESCRIPTION (provided by applicant): Atrial fibrillation (AF) affects 5.2 million Americans and over 75% of AF patients are 65 years or older. Weighing stroke risk against risk of bleeding from anticoagulants (AC) is central to AF management. Older AF patients are at highest risk for stroke and major bleeding, often curtailing prescription of AC. Therapy for AF has also become more complex in recent years with the introduction of target specific oral anticoagulants beyond warfarin. In the proposed Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, our overall objective is to enhance AC decision-making in older patients with AF by assessing previously neglected information that is part of a geriatric assessment (e.g., cognitive function, fall risk) and identifying its key elements amenable to administration in the clinic and associated with important AC outcomes (e.g., bleeding, time in therapeutic range [TTR], patient-reported AC satisfaction). We will conduct geriatric assessments every 6 months for 2 years in a diverse sample of 1,200 older AF patients at high stroke risk (CHA2DS2-VASc≥2) recruited from 5 ambulatory clinics in Central MA and GA. The specific Aims of the proposed project are: 1. Relate components of a geriatric assessment, based on validated measures of psychosocial and cognitive function and frailty, to use and type of AC, and compare how elements of the geriatric assessment change over time in AC users and non-users. 2. Among AF patients receiving AC, relate geriatric assessment measures at baseline to indicators of successful AC (e.g., bleeding, TTR, and patient satisfaction), 3. Among AF patients receiving AC, relate change in geriatric assessment measures to indicators of successful AC (bleeding, TTR and patient satisfaction) and evaluate whether this association varies by AC type. Our findings will contribute important information on novel and parsimonious risk stratifiers for optimal anticoagulation and clinical and quality of life outcomes in older patients with AF. We will also disseminate our results in a novel and user-friendly was by preparing a concise, easy to use geriatric AF resource based on our results that is comprised of key geriatric elements, all of which will be freely available in the public domain, and instructions for administration and interpretation. This Geriatric AF Resource will accelerate the uptake of our findings and enhance the clinical impact of SAGE-AF.

 描述（由适用提供）：房颤（AF）影响520万美国人，超过75％的AF患者为65岁或以上。权衡中风风险与抗凝剂流血风险（AC）是AF管理的核心。年龄较大的AF患者的中风和重度出血的风险最高，通常会减少AC处方。近年来，随着Warfarin以外的目标特定的口服抗凝剂的引入，对AF的治疗也变得更加复杂。在对房颤（Sage-AF）研究中对老年元素进行系统评估的拟议系统评估中，我们的总体目标是通过评估先前忽视的AF患者的AC决策来增强AC的决策，这些信息是先前被忽视的信息，这些信息是老年评估的一部分治疗范围[TTR]，患者报告的AC满意度）。我们将在1,200名年龄较大的AF患者的潜水员样本中进行每6个月的老年评估，其中2年的中风风险（CHA2DS2-VASC≥2）从MA和GA中的5个门诊诊所招募。拟议项目的具体目的是：1。基于经过验证的心理社会和认知功能和脆弱的措施，将老年评估的组成部分与AC的使用和类型相结合，并比较AC用户和非用户的老年评估元素如何随时间变化。 2。在接受AC的AF患者中，基线时的老年评估指标与成功的AC的指标（例如，出血，TTR和患者满意度），3。在接受AC的AF患者中，老年评估评估指标的变化与成功的AC的指标（TREDing，TTR和患者满意度）以及AC类型是否相关。我们的发现将为小说和简约的风险阶层提供重要信息 为了最佳的抗凝治疗，老年患者的临床和生活质量。我们 还将通过基于我们的结果来准备简洁，易于使用的老年AF资源的新颖和用户友好的结果，这些结果包括关键的老年元素的结果，所有这些元素都将在公共领域中免费提供，以及用于管理和解释的说明。这种老年AF资源将加速我们的发现的吸收，并增强Sage-AF的临床影响。