Optimizing Treatment of Older Adults with Hypertension: A Net Benefit Analysis of Falls Injury vs Cardiovascular Outcomes

优化老年高血压患者的治疗：跌倒损伤与心血管结果的净效益分析

基本信息

批准号：
9250056
负责人：
Lillian Chiang Min
金额：
$ 32.88万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-01 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9250056
关键词：
Acute Adherence Adult Affect Age Ambulatory Care American Benefits and Risks Blood Pressure Cardiac Cardiovascular system Caring Cessation of life Characteristics Chronic Clinical Clinical Treatment Comorbidity Data Data Set Databases Diabetes Mellitus Disputes Elderly Electronic Health Record Event Fall injury Fright Future Goals Guidelines Health Health Status Health and Retirement Study Health system Healthcare Healthcare Systems Heart failure Hip Fractures Hypertension Hypotension Individual Injury Interview Joints Link Long-Term Care Measures Medical Medicare Medicare claim Methods Modeling Myocardial Infarction Outcome Patients Performance Pharmaceutical Preparations Population Prevalence Public Health Recommendation Reporting Research Risk Risk Reduction Severities Statistical Methods Stroke Taxonomy Testing Variant Veterans Work adverse outcome aggressive therapy arm blood pressure reduction blood pressure regulation cardiovascular disorder risk cardiovascular risk factor clinical practice common treatment control trial cost disorder risk epidemiology study fall risk falls functional decline health administration hypertension control improved innovation older patient patient oriented patient population population survey prevent public health relevance young adult

项目摘要

DESCRIPTION (provided by applicant): Every year, one in 10 older people fall and sustain injury requiring medical care. Fall-related injury is the number one cause of accidental death in older Americans. However, fall injury is rarely considered as a outcome in controlled trials, which have traditionally focused on death and cardiovascular events. Until recently, we lacked methods of capturing fall-related injury in large healthcare databases. We will first use the Health and Retirement Study, a national study of older Americans, to develop a method of classifying severe fall injury in found in Medicare claims data across acute, ambulatory, and long-term care (Aim 1). Next, we will study how a national healthcare system, the Veterans Health Administration (VHA), delivers aggressive hypertension care (AHC) and whether AHC results in net benefit or harm due to cardiovascular events and severe fall-related injury. Hypertension is the single most common chronic condition in older adults. Medication treatment prevents important cardiovascular events (strokes, myocardial infarctions and heart failure), however also contributes to risk of falls. We do not fully understand the net benefits and harms among our oldest patients in clinical practice, especially after age 75 - those most prone to severe fall-injury. Thus, we aim to study the net harms and benefits associated with AHC, defined as low blood pressure (BP, <130/65 mmHg) and prescribed =3 BP medications. We have demonstrated that the VHA, a national leader in hypertension care, has used performance measures to improve care but increased rates of AHC - especially among older Veterans. The average BP for those with AHC was 114/58 mmHg - lower than the aggressive treatment arm in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. A study that captures AHC, achieved BP, and falls injury is needed. Such a study is not possible anywhere except in the VHA. In the VHA, we have carefully used sophisticated electronic databases to identify the older patients with AHC. We will study whether certain types of VHA facilities are more likely to deliver AHC to their older patients (Aim 2), then test whether AHC increases short-term risk of injurious falls (Aim 3A). Last, we will compare whether net harm results from AHC when considering both severe fall-related injury and cardiovascular events (Aim 3B). This research will inform which patients and facilities should be targeted for future efforts to reduce AHC. Innovation. This research includes innovative methods of using claims data across acute, ambulatory, and long term care data and cutting-edge statistical methods of modeling multiple outcomes to determine whether the harm of AHC outweighs the benefit of cardiovascular event reduction. Impact. Optimizing risks and benefits of approaches to hypertensive care is patient-centered and has implications for the broader health and care of older adults. At the patient level, health care information about low benefit and potential harm is critical to make informed decisions. At the population level, improved methods of optimizing treatment targets can apply to broader clinical tradeoffs in older patient populations.

描述（由申请人提供）：每年，十分之一的老年人跌倒并受伤，需要医疗护理。跌倒相关的伤害是美国老年人意外死亡的首要原因。然而，跌倒受伤很少被视为一种结果。传统上关注死亡和心血管事件的对照试验，直到最近，我们还缺乏在大型医疗数据库中捕获跌倒相关伤害的方法。我们将首先使用健康与退休研究（一项针对老年人的全国性研究）来开发一项研究。分类方法在急性、门诊和长期护理的医疗保险索赔数据中发现严重跌倒伤害（目标 1）接下来，我们将研究国家医疗保健系统退伍军人健康管理局 (VHA) 如何提供积极的高血压护理 (AHC)。高血压是老年人最常见的慢性疾病，药物治疗可预防重要的心血管事件（中风、心肌梗死和心力衰竭）。然而，我们并不完全了解临床实践中最年长患者的净益处和危害，尤其是 75 岁以上的患者——最容易发生严重跌倒损伤的患者。与 AHC 相关的益处，定义为低血压（BP，<130/65 mmHg）和处方 = 3 种 BP 药物。我们已经证明，高血压护理领域的全国领导者 VHA 已使用绩效措施来改善护理，但提高了比率。的AHC - 特别是在老年退伍军人中，患有 AHC 的人的平均血压为 114/58 mmHg - 低于控制糖尿病心血管风险行动 (ACCORD) 试验中的积极治疗组，该研究记录了 AHC、达到血压和下降情况。除了 VHA 之外，在任何地方都不可能进行此类研究。在 VHA 中，我们仔细使用了复杂的电子数据库来识别 AHC 老年患者。我们将研究某些类型的 VHA 设施是否更适合。可能向老年患者提供 AHC（目标 2），然后测试 AHC 是否会增加短期伤害性跌倒风险（目标 3A）最后，我们将比较在考虑严重跌倒相关伤害和严重跌倒相关伤害时 AHC 是否会造成净伤害。心血管事件（目标 3B）。这项研究将告知哪些患者和机构应成为未来减少 AHC 的目标。这项研究包括使用急性、门诊和长期护理数据的创新方法和尖端创新。统计方法对多种结果进行建模以确定 AHC 的危害是否大于减少心血管事件的益处。优化高血压护理方法的风险和益处是以患者为中心的，并且对患者的更广泛的健康和护理具有影响。在人群层面，有关低效益和潜在危害的医疗保健信息对于做出明智的决策至关重要。在人群层面，优化治疗目标的改进方法可以应用于老年患者群体更广泛的临床权衡。