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（由申请人提供）：心房颤动 (AF) 影响着 520 万美国人，超过 75% 的 AF 患者年龄在 65 岁或以上。权衡中风风险与抗凝剂 (AC) 出血风险是老年 AF 患者管理的核心。中风和大出血的风险最高，近年来，随着目标特异性口服药物的引入，房颤的治疗处方也变得更加复杂。在拟议的房颤老年因素系统评估 (SAGE-AF) 研究中，我们的总体目标是通过评估老年房颤评估中先前被忽视的信息来加强房颤老年患者的房颤决策。例如，认知功能、跌倒风险），并确定其适合临床给药并与重要 AC 结局相关的关键要素（例如，出血、治疗范围内的时间 [TTR]、我们将在两年内每 6 个月对从马萨诸塞州中部和乔治亚州 5 个门诊诊所招募的 1,200 名高卒中风险老年 AF 患者（CHA2DS2-VASc≥2）进行老年评估。拟议项目的目标是： 1. 根据经过验证的心理社会和认知功能及虚弱测量，将老年评估的各个组成部分联系起来，以使用 AC 和 AC 类型，并进行比较AC 使用者和非使用者的老年评估要素如何随时间变化 2. 在接受 AC 的 AF 患者中，将基线时的老年评估指标与成功 AC 的指标（例如出血、TTR 和患者满意度）联系起来， 3.在 AF 患者 AC 中，将老年接受评估措施的变化与成功 AC 的指标（出血、TTR 和患者满意度）联系起来，并评估这种关联是否因 AC 类型而异。我们的研究结果将为新的和简约的风险提供重要信息。分层器 为老年 AF 患者提供最佳的抗凝治疗以及临床和生活质量结果。 还将以一种新颖且用户友好的方式传播我们的结果，即根据我们的结果准备简洁、易于使用的老年 AF 资源，该资源由关键的老年元素组成，所有这些都将在公共领域免费提供，并提供说明该老年 AF 资源将加速我们研究结果的采用并增强 SAGE-AF 的临床影响。