Optimizing Outcomes for Patients with Heart Failure and Atrial Fibrillation

项目摘要/摘要 心房颤动(房颤)是成人最常见的持续性心律失常，其发病率和致残率较高。 死亡率。在病情最严重的心力衰竭患者中，房颤的患病率高达50%，而心力衰竭的预后 同时患有房颤和心力衰竭的患者非常差。然而，房颤对心力衰竭患者的负担已有报道。 (专业)不是很好的描述。此外，虽然导管消融治疗房颤与整体改善有关 结果，并不是所有的患者都从消融中受益。我寻求有指导的研究职业发展的目标 获奖是为了获得必要的培训和经验，以发展专注于独立研究的职业 关于改善心律失常患者的个人化治疗和结果。 在这项提案中，我们将通过3个项目，弥合心力衰竭和房颤患者管理方面的知识空白。 具体目的：(1)比较心力衰竭患者合并房颤与不合并房颤的优劣； 描述房颤和心力衰竭患者接受房颤消融的临床过程；以及(3)确定患者 房颤和心衰最有可能从房颤消融中受益。利用伊利诺伊大学独有的资源 犹他州，拟议的AIMS将为共同发生的心衰和房颤的负担提供新的见解 使用客观的、结构化的和系统的收集经过验证的PRO测量的生活质量 在整个医疗系统中。 这项职业发展计划将由国际知名的健康领域专家指导 房颤、高频治疗和房颤消融的服务研究、优点、结果：瑞秋·赫斯博士，卫生部长 犹他州PRO项目的系统创新和研究和医学主任；James Fang博士和Josef博士 Stehlik，高频领域的思想领袖；Jonathan Piccini博士和Nassir Marrouche博士，电生理学家和 房颤消融领域的国际领导者；专业研究的先驱约翰·斯珀图斯博士；以及汤姆·格林教授， 一位经验丰富的统计主任。与正式的教学相结合，他们将提供必要的支持 实现我的培训目标，在以下方面培养技能：(1)专业知识的使用和解释；(2)分析 纵向结果；(3)治疗效果异质性的多变量预测模型的使用。 综上所述，提出的科学目标的结果将有助于指导患者的治疗 HF和AF。随着培训目标的完成，我将被独特地定位为侵入性、临床性、 心脏电生理学家，受过严格的观察研究方法的教育，重点是 论治疗效果的利弊和异质性。建议的职业发展补助金建议 将为我提供必要的技能，以成功地实现我的目标，即建立一个独立的 旨在为心律紊乱患者提供个性化治疗的研究计划。

PROJECT SUMMARY/ABSTRACT Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and leads to significant morbidity and mortality. Among the sickest patients with heart failure (HF), AF prevalence is up to 50%, and the prognosis of patients with both AF and HF is very poor. However, the burden of AF on HF patient reported outcomes (PROs) is not well-described. Additionally, while catheter ablation for AF is associated with improved overall outcomes, not all patients benefit from ablation. My goal in seeking a Mentored Research Career Development Award is to acquire the necessary training and experience to develop an independent research career focused on improving personalization of treatment and outcomes for patients with heart rhythm disorders. In this proposal we will close knowledge gaps in the management of patients with HF and AF, through the 3 specific aims, which are to: (1) compare PROs between HF patients with and without co-existing AF; (2) describe the clinical course of patients with AF and HF undergoing AF ablation; and (3) identify patients with AF and HF most likely to benefit from ablation for AF. Leveraging resources unique to the University of Utah, the proposed aims will provide novel insights into the burden of co-occurring HF and AF on quality of life using objective, structured, and systematic collection of validated PROs measures across the healthcare system. This career development plan will be mentored by internationally-renowned experts in the fields of health services research, PROs, outcomes in AF, HF therapies, and AF ablation: Dr. Rachel Hess, Chief of Health System Innovation and Research and Medical Director of the Utah PRO program; Drs. James Fang and Josef Stehlik, thought-leaders in HF; Drs. Jonathan Piccini and Nassir Marrouche, electrophysiologists and international leaders in AF ablation; Dr. John Spertus, a pioneer in PRO research; and Professor Tom Greene, an experienced statistical director. Combined with formal didactics, they will provide the support needed to achieve my training aims, developing skills in: (1) the use and interpretation of PROs; (2) analyses of longitudinal outcomes; and (3) the use of multivariable predictive modeling of treatment effect heterogeneity. In summary, the results of the proposed scientific aims will help guide the treatment of patients with HF and AF. With completion of the training aims, I will be uniquely-positioned as an invasive, clinical, cardiac electrophysiologist, educated in rigorous observational research methods with an emphasis on PROs and heterogeneity of treatment effects. The proposed Career Development Grant proposal will provide me the necessary skills to successfully pursue my goal of establishing an independent research program geared towards personalizing treatments for patients with heart rhythm disorders.