Optimizing Atrial Fibrillation Management in CKD

优化 CKD 中的房颤管理

基本信息

批准号：
10115106
负责人：
Nisha Bansal
金额：
$ 72.44万
依托单位：
UNIVERSITY OF WASHINGTON
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：
2019-06-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10115106
关键词：
Adult Adverse effects Affect American Anti-Arrhythmia Agents Anticoagulation Arrhythmia Atrial Fibrillation Bradycardia California Canada Cardiovascular system Cessation of life Chronic Chronic Kidney Failure Clinical Communities Data Effectiveness End stage renal failure Evaluation Event Failure Functional disorder Future Glomerular Filtration Rate Goals Healthcare Systems Heart Rate Heart failure Hemorrhage Kidney Kidney Diseases Link Measures Methodology Network-based North America Observational Study Ontario Outcome Patients Pharmaceutical Preparations Population Procedures Province Publishing Renal clearance function Renal function Reproducibility Research Risk Safety Sinus Stroke System Testing Therapeutic Time Update Validation Warfarin acute coronary syndrome appropriate dose base cohort community based practice comparative effectiveness analysis cost efficient design experience follow-up health care delivery high risk improved improved outcome mortality risk multidisciplinary patient population population based practice setting response

项目摘要

ABSTRACT Atrial fibrillation (AF) is the most common sustained arrhythmia, currently affecting >33.5 million adults world- wide, with the highest rates in North America. Chronic kidney disease (CKD) is also highly prevalent and affects 14% of the U.S. and North American population. The burden of AF is 3-fold higher in CKD and affects up to 25% of CKD patients. AF is linked to poor outcomes. Our data demonstrate that among patients with CKD, incident AF is associated with a 3-to-7-fold greater risk of heart failure (HF), acute coronary syndromes (ACS), stroke, death and progression to end-stage renal disease (ESRD) vs. CKD patients without AF. Despite the high risks associated with AF, it is unknown whether AF therapies improve outcomes in the setting of CKD. The unique pathophysiology of AF in CKD, the effects of decreased renal clearance, as well as competing risks of non-AF related death may alter the effectiveness and safety of commonly used AF medications and procedures in CKD. To our knowledge, no published studies have evaluated the collective influence of AF therapies on kidney and cardiovascular outcomes in CKD. Trials of AF therapies have largely excluded patients with CKD. Prior observational studies have several notable limitations: (1) focus only on warfarin and not a comprehensive evaluation of other AF therapies; (2) focus only on stroke and death as outcomes; and (3) inadequate consideration of interim clinical measures that may affect receipt and outcomes of AF therapies. Our overall goal is to use "real-world" contemporary data to evaluate the risks vs. benefits of various AF therapies, including medications and procedures, in adults with CKD. We will perform a comparative effectiveness analysis to delineate whether treatment of AF impacts important kidney and cardiovascular outcomes in patients with vs. without CKD. To conduct these aims, we will use the Cardiovascular Research Network (CVRN) platform to study a community-based network of ~267,000 patients with AF from two participating health care systems in California; and we will externally validate these findings in a community- based cohort of ~392,000 patients in Ontario, Canada. We will evaluate the use, response and safety of current AF therapies (including anticoagulation, rate control agents, anti-arrhythmic agents and AF-related procedures) in patients with vs. without CKD. We will perform a comparative effectiveness analysis to delineate whether treatment of AF impacts important kidney and cardiovascular outcomes in patients with vs. without CKD. The data from this study may provide guidance for an integrated AF management approach to improve clinical outcomes in CKD and inform the design of future trials of patients with AF and CKD.

抽象的心房颤动 (AF) 是最常见的持续性心律失常，目前影响全球超过 3350 万成年人范围广泛，在北美地区的比率最高。慢性肾病（CKD）也非常普遍，影响 14% 的美国和北美人口。 CKD 患者的 AF 负担高出 3 倍，并影响高达 25% 的 CKD 患者。房颤与不良结果有关。我们的数据表明，在患有以下疾病的患者中 CKD、AF 事件与心力衰竭 (HF)、急性冠状动脉综合征的风险增加 3 至 7 倍相关与无 AF 的 CKD 患者相比，（ACS）、中风、死亡和进展为终末期肾病（ESRD）。尽管由于与 AF 相关的高风险，目前尚不清楚 AF 治疗是否可以改善 CKD 患者的预后。 CKD 中 AF 的独特病理生理学、肾清除率降低的影响以及竞争性非房颤相关死亡的风险可能会改变常用房颤药物的有效性和安全性， CKD 程序。据我们所知，尚未发表的研究评估 AF 的集体影响 CKD 肾脏和心血管结局的治疗。房颤治疗试验基本上排除了慢性肾病患者。先前的观察性研究有几个明显的局限性：（1）仅关注华法林和不是对其他房颤疗法的综合评价； (2) 仅关注中风和死亡作为结果；和（3）对可能影响 AF 治疗接受和结果的临时临床措施考虑不足。我们的总体目标是使用“真实世界”的当代数据来评估各种 AF 的风险与收益成人 CKD 患者的治疗方法，包括药物和手术。我们将进行一个对比有效性分析，以确定房颤治疗是否影响重要的肾脏和心血管患有 CKD 的患者与未患有 CKD 的患者的结果。为了实现这些目标，我们将利用心血管研究网络 (CVRN) 平台，用于研究基于社区的网络，该网络由来自两个国家的约 267,000 名 AF 患者组成加州参与的医疗保健系统；我们将在社区中外部验证这些发现- 加拿大安大略省约 392,000 名患者的队列。我们将评估其使用、反应和安全性目前的 AF 治疗方法（包括抗凝剂、心率控制剂、抗心律失常剂和 AF 相关药物） CKD 患者与非 CKD 患者的对比。我们将进行比较有效性分析来描述房颤治疗是否会影响房颤患者与非房颤患者的重要肾脏和心血管结局慢性肾病。这项研究的数据可以为综合房颤管理方法提供指导，以改善 CKD 的临床结果，并为 AF 和 CKD 患者的未来试验设计提供信息。