Peripheral Artery Disease: Long-term Survival & Outcomes Study (PEARLS)

外周动脉疾病：长期生存

• 批准号: 10744868
• 负责人: Saket Girotra
• 金额: $ 46.1万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10744868
• 关键词: Peripheral; Artery; Disease; Long; term

Project Summary/Abstract Background: Peripheral artery disease (PAD) is a common and highly morbid condition. Nearly 25% of patients die within 3 years of diagnosis, likely due to a high incidence of cardiovascular (CV) events: myocardial infarction (MI) or stroke. A significantly larger proportion experience disability due to leg pain, poor mobility and amputation. The cost of PAD-related hospital care alone exceeds $21 billion. However, research regarding long-term survival, CV, and limb outcomes in PAD and the impact of existing treatments remain limited in large part due to the poor accuracy of PAD diagnosis codes. Our team has developed a novel approach using natural language processing (NLP) to identify PAD patients with a high degree of accuracy within the Veterans Health Administration (VHA). Significance: The Peripheral Artery Disease: Long-term Survival & Outcomes Study (PEARLS) study will advance scientific knowledge for PAD in several ways. We will use our NLP tool to assemble one of the largest cohorts of PAD in the world and follow them long-term to assess the trajectory of survival and clinical outcomes, evaluate utilization of recommended treatments (medications, risk factor control and revascularization) and the association of above treatments with the above outcomes. Collectively, our work will address important gaps in PAD research and yield insights regarding strategies to improve care delivery in this high-risk population. Innovation: The use of an informatics-based method to assemble a cohort of newly diagnosed PAD patients in a large integrated health system is highly innovative. We believe that our approach for cohort identification will be transformational and promote big data analytics for research, improving care delivery, and future clinical trials. Specific Aims: A1. Develop a national cohort of Veterans with newly diagnosed PAD using a novel NLP algorithm. A2. Examine patterns of medical and invasive management and determine patient- and facility-level correlates. A3. Determine the impact of medical and invasive management of PAD on long-term outcomes. Methodology: We will implement our NLP algorithm to identify patients with new PAD diagnosis in VHA during 2015-2020 and obtain data on clinical and treatment related variables. We will follow our cohort longitudinally for mortality, CV events (MI, stroke) and limb events (amputation). We will examine utilization of PAD treatments and risk factor control, identify patient-level and hospital-level predictors of treatment using multi-level models. We will use discrete survival models to evaluate the association of PAD treatments with long-term outcomes. Implementation/Next Steps: Key deliverables will include a) an understanding of which patient groups are at greatest risk for mortality and adverse outcomes; (b) determining the relative impact of PAD treatments on long- term outcomes which can be useful for decision-making and c) an assessment of site-level variation in treatment patterns. We envision that our findings will help us develop comprehensive disease management program to improve quality of care and reduce disparities in use of effective treatments.

项目摘要/摘要 背景：周围动脉疾病（PAD）是一种常见且高度病态的疾病。近25％的患者 诊断后的3年内死亡，可能是由于心血管（CV）事件的高发病率。 （MI）或中风。由于腿部疼痛，流动性和截肢差而导致的经历障碍的比例要大得多。 与PAD相关的医院护理的成本超过210亿美元。但是，有关长期生存的研究， CV和PAD中的肢体结果以及现有治疗的影响在很大程度上仍然有限 PAD诊断代码的准确性。我们的团队使用自然语言处理开发了一种新颖的方法 （NLP）识别退伍军人卫生管理（VHA）中具有高度准确性的PAD患者。 意义：周围动脉疾病：长期生存与结局研究（珍珠）研究将 通过多种方式提高垫子的科学知识。我们将使用NLP工具组装最大的工具之一 世界上的PAD队列，并长期跟随它们，以评估生存和临床结局的轨迹， 评估推荐治疗的利用（药物，风险因素控制和血运重建）和 上述处理与上述结果的关联。总的来说，我们的工作将解决重要的差距 PAD研究并产生有关改善此高风险人群护理提供的策略的见解。 创新：使用基于信息学的方法组装新诊断的PAD患者队列 大型综合卫生系统具有很高的创新性。我们相信我们的队列识别方法将 进行变革并促进大数据分析，以进行研究，改善医疗服务和未来的临床试验。 具体目的：A1。使用新颖的NLP开发新诊断的退伍军人队列 算法。 A2。检查医疗和侵入性管理的模式，并确定患者和设施级别 相关。 A3。确定PAD的医疗和侵入性管理对长期结果的影响。 方法论：我们将实施我们的NLP算法，以识别VHA中有新的PAD诊断的患者 2015-2020并获取有关临床和治疗相关变量的数据。我们将纵向遵循我们的队列 死亡率，简历事件（MI，中风）和肢体事件（截肢）。我们将检查PAD治疗的利用 以及风险因素控制，使用多级模型确定治疗的患者水平和医院水平预测指标。 我们将使用离散的生存模型来评估PAD处理与长期结局的关联。 实施/下一步：关键可交付成果将包括a）了解哪些患者群体在 死亡率和不利结果的最大风险； （b）确定PAD处理对长期的相对影响 术语结果对于决策和c）评估现场级别的治疗差异 模式。我们设想我们的发现将帮助我们制定全面的疾病管理计划 提高护理质量并减少使用有效治疗的差异。

项目成果

Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure.

使用针对心力衰竭的风险标准化再入院率和死亡率的复合种族特定指标，实现医院绩效评估的公平性。

• DOI: 10.1161/circulationaha.122.061995
• 发表时间: 2023
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Mentias,Amgad;Peterson,EricD;Keshvani,Neil;Kumbhani,DharamJ;Yancy,ClydeW;Morris,AlannaA;Allen,LarryA;Girotra,Saket;Fonarow,GreggC;Starling,RandallC;Alvarez,Paulino;Desai,MilindY;Cram,Peter;Pandey,Ambarish
• 通讯作者: Pandey,Ambarish

Acute Myocardial Infarction: Etiologies and Mimickers in Young Patients.

• DOI: 10.1161/jaha.123.029971
• 发表时间: 2023-09-19
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Krittanawong, Chayakrit;Khawaja, Muzamil;Tamis-Holland, Jacqueline E.;Girotra, Saket;Rao, Sunil V.
• 通讯作者: Rao, Sunil V.

Prognostic Significance of Newly Diagnosed Atrial Fibrillation After Acute Myocardial Infarction: A Study of 184,980 Medicare Patients.

急性心肌梗死后新诊断心房颤动的预后意义：对 184,980 名医疗保险患者的研究。

• DOI: 10.1016/j.carrev.2022.06.258
• 发表时间: 2022
• 期刊: Cardiovascular revascularization medicine : including molecular interventions
• 作者: Ayinde,Hakeem;Riedle,Benjamin;Ojo,Amole;Abugroun,Ashraf;Girotra,Saket;Polgreen,Linnea
• 通讯作者: Polgreen,Linnea

Long-Term Outcomes for Out-of-Hospital Cardiac Arrest in Elderly Patients: An Analysis of Cardiac Arrest Registry to Enhance Survival Data Linked to Medicare Files.

• DOI: 10.1161/circoutcomes.122.009042
• 发表时间: 2022-10
• 期刊: CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
• 影响因子: 6.9
• 作者: Chan, Paul S.;McNally, Bryan;Chang, Anping;Girotra, Saket;Al-Araji, Rabab;Mawani, Minaz;Ahn, Ki Ok;Merritt, Robert
• 通讯作者: Merritt, Robert

Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial.

• DOI: 10.1001/jamacardio.2023.3364
• 发表时间: 2023-11-01
• 期刊: JAMA CARDIOLOGY
• 影响因子: 24
• 作者: Sleem, Amber;Effron, Mark B.;Stebbins, Amanda;Wruck, Lisa M.;Marquis-Gravel, Guillaume;Munoz, Daniel;Re, Richard N.;Gupta, Kamal;Pepine, Carl J.;Jain, Sandeep K.;Girotra, Saket;Whittle, Jeffrey;Benziger, Catherine P.;Farrehi, Peter M.;Knowlton, Kirk U.;Polonsky, Tamar S.;Roe, Matthew T.;Rothman, Russell L.;Harrington, Robert A.;Jones, W. Schuyler;Hernandez, Adrian F.
• 通讯作者: Hernandez, Adrian F.