Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients

老年心力衰竭患者的多重发病率和治疗相关结果

基本信息

批准号：
10013113
负责人：
Mayra S. Tisminetzky
金额：
$ 58.22万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10013113
关键词：
Address Adrenergic beta-Antagonists Adult Affect Age-Years Aging Anemia Angiotensin II Receptor Angiotensin-Converting Enzyme Inhibitors Bradycardia Cardiovascular system Caring Cessation of life Chronic Chronic Kidney Failure Clinical Clinical Management Clinical Practice Guideline Clinical Trials Clinical effectiveness Communities Data Data Set Decision Making Diabetes Mellitus Disease Diuretics Effectiveness Elderly Electronic Health Record Fasting Geography Goals Grant Health Status Heart failure Heterogeneity Hospitalization Individual Investigation Knowledge Left Ventricular Ejection Fraction Lung diseases Medical Methods Mineralocorticoid Receptor Morbidity - disease rate National Institute on Aging Natural Language Processing Older Population Outcome Patients Pattern Persons Pharmaceutical Preparations Pharmacotherapy Population Quality of Care Renin-Angiotensin-Aldosterone System Research Risk Safety Sodium Syncope Syndrome System Technology Therapeutic Treatment Failure United States Dept. of Health and Human Services adverse outcome base cohort common treatment comorbidity effectiveness evaluation follow-up health care delivery high risk hyperkalemia improved insight kidney dysfunction mortality risk multiple chronic conditions novel patient subsets population based practice setting preservation randomized trial response unstructured data

项目摘要

PROJECT SUMMARY/ABSTRACT Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, typically defined as the presence of ≥2 chronic conditions, increases the risks of hospitalization and death in older HF patients, and greatly complicates the clinical management of HF. Caution is required in applying national clinical practice guidelines to the care of older adults with multimorbidity, as this could result in undesirable net effects and less than optimal outcomes including adverse interactions between drugs and various concomitant diseases. In response to PA-17-088 (Exploratory Analyses of Existing Cohorts, Data Sets, and Stored Biospecimens to Address Clinical Aging Research Questions, R01), we propose to leverage an existing HF cohort, including data for more than 100,000 patients with HF within the Cardiovascular Research Network between 2005-2012, with follow-up data up to 2017. We will extend our previous efforts by examining treatment patterns and the net benefits versus harms of selected therapies in older adults with HF and a wide spectrum of multimorbidity burden. We will further examine the benefits and adverse outcomes of various therapies focusing on particularly vulnerable subgroups of patients with HF afflicted by two prevalent conditions, anemia or diabetes. Our specific aims are: (1) to examine the effectiveness of selected medical therapies (renin-angiotensin- aldosterone system blockers, beta-blockers, diuretics, and aldosterone receptor blockers) on death, HF hospitalization, and all-cause hospitalizations in a large, community-based population of older adults with HF across a range of levels of multimorbidity burden and left ventricular ejection fraction; (2) to evaluate targeted adverse outcomes, including kidney dysfunction, hyperkalemia, sodium disturbances, bradycardia, and syncope associated with selected HF therapies in older adults with HF, stratified by multimorbidity burden and left ventricular ejection fraction status; and (3) to characterize the potential benefits and adverse outcomes associated with selected HF therapies in older adults with HF and two prevalent comorbidity dyads—HF- diabetes and HF-anemia—that are common and substantially increase the risks of death and morbidity. In addition, we will create novel, validated methods to identify adverse outcomes related to HF therapies from unstructured data in large electronic health record systems through natural language processing technology, along with employing state-of-the-art analytic approaches to evaluate treatment-related outcomes. In that our proposed investigation will take advantage of a large, geographically and demographically diverse cohort of adults with HF receiving care within community-based healthcare delivery systems, we anticipate our findings will be highly generalizable to the broad spectrum of older adults with HF managed in “real-world” practice settings.

项目摘要/摘要心力衰竭（HF）是老年人住院最常见的。 HF住院的年龄为65岁或年龄。慢性病，增加了老年HF患者的住院风险和死亡的风险，以及吞噬HF的临床管理。照顾有多个幸运的老年人，因为罐子的净效果不佳，小于最佳结果，包括药物与各种伴随疾病之间的不良相互作用对PA-17-088的响应（现有队列的探索性分析解决临床老化研究问题，R01），我们建议利用现有的HF队列，包括在心血管研究网络BETWORK 2005-2012中，超过100,000名HF患者的数据，随着后续数据截至2017年。我们将通过检查治疗模式和网络扩大以前的效率 HF老年人和多种多发病的老年人中所选疗法的益处与危害负担。我们将进一步研究各种疗法的益处尤其是患有两种普遍病情，贫血或糖尿病的HF患者的易感性亚组。我们的具体目的是：（1）检查选定的医疗疗法的有效性（肾素 - ngiotensin- 死亡，HF HF的大量，基于社区的老年人的住院和全因住院在一系列多维地负担和左心室射血分数的范围内；不良后果，含有肾脏功能障碍，高钾血症，钠干扰，心动过缓，以及与HF的老年人相关的晕厥，由多通信负担分层和左心室弹出状态；（3）来表征潜在的好处与HF和两个普遍的Comiolbides的老年人中选定的HF疗法有关-HF- 糖尿病和HF贫血 - 很常见，并大大增加了死亡和病态的风险此外，我们还将创建新颖的，经过验证的方法，以识别与HF疗法相关的不良结果大型电子健康记录中的非结构化数据通过自然语言处理技术，同时采用最先进的分析方法来评估与治疗相关的结果支撑的调查将利用大型，地理和人口统计多样的队列在基于社区的医疗保健服务系统中接受HF接受护理的成年人在“现实世界”实践中管理HF的老年人的广泛范围将高度推广设置。