Pandemic Disruptions of Atrial Fibrillation Care

心房颤动护理的大流行中断

基本信息

批准号：
10656222
负责人：
Inmaculada Hernandez
金额：
$ 50.56万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10656222
关键词：
Adherence Affect Age Anticoagulants Anticoagulation Area Arrhythmia Atrial Fibrillation Blood Tests COVID-19 pandemic COVID-19 pandemic effects Cardiac Cardiovascular Diseases Cardiovascular system Caring Cessation of life Chronic Disease Clinical County Data Diagnosis Disease Disparity Electronic Health Record Emergency Situation Emergency response Ethnic Origin Event Fee-for-Service Plans Future Goals Health Hemorrhage Hospitalization Incidence Individual International Normalized Ratio Interruption Laboratories Link Measures Medical Records Medicare Minority Modeling Modification Monitor Newly Diagnosed Oral Outcome Patient-Focused Outcomes Patients Persons Policies Population Prevention therapy Prognosis Race Reporting Risk Role Socioeconomic Status Stroke Stroke prevention Structural Models Telemedicine Testing Therapeutic Time Time Series Analysis United States National Institutes of Health Urbanization Visit Vulnerable Populations Warfarin adverse outcome beneficiary clinical development coronavirus disease cost deprivation health care service utilization health disparity pandemic disease pandemic impact pre-pandemic prevent public health relevance segregation sex social stroke incidence stroke risk telehealth therapy adherence uptake urban area

项目摘要

Project Summary Atrial fibrillation (AF) is a cardiac arrythmia that affects over 5 million individuals in the US and quintuples the risk of stroke. AF is a critical disease state to measure the effects of the COVID-19 pandemic on non-COVID disease because every aspect of stroke prevention in AF is vulnerable to disruption: 1) Patients with new onset AF may be more likely to remain undiagnosed. 2) Established AF patients may have complications that remain undetected and worsen without treatment. 3) Patients newly diagnosed with AF may be less likely to initiate stroke prevention therapy with oral anticoagulation (OAC). 4) Established OAC users may have increased difficulty adhering to therapy. 5) Patients on warfarin, an OAC agent that requires routine blood tests, may have less frequent monitoring. Our goal is to measure the impact of the COVID-19 pandemic on diagnosis, therapy initiation, therapy adherence, monitoring, and health outcomes for patients with AF. We will determine whether pandemic disruptions of AF care have exacerbated health disparities. We will also assess the role of telemedicine, whose uptake has been catalyzed by the pandemic, in offsetting decreased access to in-person care during crises. We will use 2015-2022 claims data for Medicare fee-for-service beneficiaries and Optum® Integrated claims- electronic health record data for commercially insured and Medicare Advantage beneficiaries. We will construct interrupted time series analyses to measure changes in outcomes after pandemic start and pandemic end. To determine whether the pandemic has exacerbated disparities, we will test whether the degree of change in outcomes differed by age, sex, race/ethnicity, and area-level measures of urbanization, socioeconomic status, deprivation, racial composition, and segregation. In aims 3 and 4, we will use marginal structural models to estimate the association between telehealth visits and outcomes. We will achieve four specific aims: (1) quantify changes in the incidence rate of new AF diagnoses in 2016-2021, including new AF diagnoses manifesting as stroke; (2) determine whether the COVID-19 pandemic was associated with decreased OAC initiation among newly diagnosed AF patients; (3) quantify changes in adherence and monitoring of OAC therapy among established AF patients; (4) quantify changes in the incidence rates of stroke, bleeding, cardiovascular hospitalization, and death among established AF patients. Our quantification of pandemic effects on AF care will have major implications for the provision of chronic disease care during emergencies. Our identification of populations disproportionately affected by the pandemic and our determination of the ability of telemedicine to offset decreased access to in-person care will inform clinical guidance and policies that prevent care avoidance during health emergencies, optimize models for the delivery of chronic disease care during major crises, and protect vulnerable populations.

项目概要心房颤动 (AF) 是一种心律失常，在美国影响着超过 500 万人，使患病人数增加了五倍 AF 是衡量 COVID-19 大流行对非 COVID 影响的重要疾病状态。因为 AF 中风预防的各个方面都容易受到干扰：1) 新发患者 2) 已确诊的房颤患者可能仍存在并发症未被发现且未经治疗而恶化 3) 新诊断为 AF 的患者可能不太可能开始治疗。口服抗凝药 (OAC) 预防中风的疗法 4) 已建立的 OAC 用户可能有所增加。 5) 服用华法林（一种需要进行常规血液检查的 OAC 药物）的患者可能难以坚持治疗。监测频率较低。我们的目标是衡量 COVID-19 大流行对诊断、治疗启动、治疗的影响我们将确定 AF 患者的依从性、监测和健康结果是否大流行。房颤护理的中断加剧了健康差异。我们还将评估远程医疗的作用，其作用。大流行促进了这种做法的采用，抵消了危机期间获得面对面护理的机会的减少。我们将使用 2015-2022 年 Medicare 按服务收费受益人和 Optum® Integrated 索赔的索赔数据 - 我们将为商业保险和 Medicare Advantage 受益人构建电子健康记录数据。中断时间序列分析来衡量大流行开始和结束后结果的变化。判断疫情是否加剧了贫富差距，我们将检验变化的程度是否结果因年龄、性别、种族/族裔以及地区城市化程度、社会地位、在目标 3 和 4 中，我们将使用边际结构模型来分析贫困、种族构成和隔离。估计远程医疗就诊和结果之间的关联我们将实现四个具体目标：（1）量化2016-2021年新发AF诊断的发病率变化，包括新发AF诊断 (2) 确定 COVID-19 大流行是否与 OAC 下降有关新诊断的 AF 患者中的启动；(3) 量化 OAC 依从性和监测的变化已确定的 AF 患者的治疗；(4) 量化中风、出血、 AF 患者因心血管原因住院和死亡。我们对流行病对 AF 护理的影响的量化将对提供慢性病产生重大影响。我们确定了受大流行影响不成比例的人群。我们对远程医疗抵消面对面护理机会减少的能力的确定将告知防止突发卫生事件期间避免护理的临床指导和政策，优化模型在重大危机期间提供慢性病护理，并保护弱势群体。