The Trajectories and Clinical Experiences of ICD Therapy (TRACER-ICD) Study

项目摘要/摘要X 每年有50,000多个植入型心律转复除颤器(ICD)植入65岁以上的≥患者 预计成本为20亿美元。ICD指南借鉴了招募较少老年患者的试验，但这些患者中有一半 将在植入后5年内死亡或进入临终关怀。尽管联邦医疗保险现在强制共享 对于ICD的决策(SDM)，很少有研究调查对老年患者至关重要的问题，包括健康 状态轨迹和生活质量。改善老年患者的SDM需要超越平均治疗 效果评估纳入了对这些结果的精确建模。因此，迫切需要 支持老年人以患者为中心的SDM的纵向数据。以扩展我们先前的工作并进一步 改善老年人的SDM考虑ICD，我们提出了轨迹和临床经验 ICD治疗(TRACE-ICD)研究，一项多中心前瞻性队列研究，目标是更好地定义 老年ICD植入术中以患者为中心的目标和经验。我们会 前瞻性地收集5个地点的患者的老年状况和生活质量数据，并通过远程 监测心律失常和体力活动的数据，以评估其临床和功能轨迹(目标1)。 这一队列将支持我们统计模型的进一步改进，以个性化对治疗结果的预测 (目标2)。最后，我们将使用混合方法来确定翻译这些内容的最佳实施策略 ICD个体化预测模型(目标3)。该提案由早期研究人员牵头 其在心脏电生理学、老年医学和结果研究方面的专业知识将得到补充 由一支经验丰富、有很强的合作记录的研究团队提供。 影响：作为第一项针对老年ICD患者的全面、前瞻性研究，TRACE-ICD将产生 独特的以患者为中心的个性化数据对于描述这一常见手术的结果至关重要 在脆弱的人群中。就像其他对老年人的大型队列研究一样，我们预计会有强劲的数据 从示踪剂-ICD中脱颖而出将成为一个丰富的资源，将改善数百万患者的护理 考虑ICD植入，并为个性化翻译提供必要的循证指导 SDM体验中的结果简档。

Project Summary / Abstract X Over 50,000 implantable cardioverter-defibrillators (ICDs) are implanted annually in patients ≥65 years old at an estimated cost of >$2 billion. ICD guidelines draw upon trials enrolling few older patients, yet half of these patients will either be dead or enrolled in hospice within 5 years of implantation. Though Medicare now mandates shared decision-making (SDM) for ICDs, few studies have investigated questions vital for older patients, including health status trajectories and quality of life. Improved SDM for older patients requires moving beyond average treatment effect estimates to incorporate precision modeling of these outcomes. There is therefore a pressing need for longitudinal data to support patient-centered SDM for older adults. To extend our prior work and further improve SDM for older adults considering an ICD, we propose the TRAjectories and Clinical ExpeRiences of ICD Therapy (TRACER-ICD) Study, a multi-center prospective cohort with the goal of better defining patient-centered goals and experiences in older patients undergoing ICD implantation. We will prospectively collect data on geriatric conditions and quality of life from patients at 5 sites, enriched with remote monitoring data on arrhythmias and physical activity, to evaluate their clinical and functional trajectories (Aim 1). This cohort will support further refinement of our statistical model to personalize prediction of treatment outcomes (Aim 2). Lastly, we will use mixed methods to identify optimal implementation strategies for translating these individualized prediction profiles into SDM for ICDs (Aim 3).This proposal is led by an Early Stage Investigator whose expertise in cardiac electrophysiology, geriatric medicine, and outcomes research will be complemented by an experienced research team with a strong record of collaboration. IMPACT: As the first comprehensive, prospective study of older ICD patients, TRACER-ICD will generate unique patient-centered and personalized data essential for characterizing outcomes of this common procedure in a vulnerable population. Much like other large cohort studies in older persons, we anticipate the robust data emerging from TRACER-ICD will serve as a rich resource that will improve care for millions of patients considering ICD implantation, and provide essential, evidence-based guidance for translating personalized outcome profiling into the SDM experience.