Identification of the Components of Frailty Using Administrative Data and Metabolite Profiling

使用管理数据和代谢物分析识别虚弱的组成部分

基本信息

批准号：
10441266
负责人：
Jordan Blair Strom
金额：
$ 17.28万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
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：
2019-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10441266
关键词：
Adult Adverse event Age Aortic Valve Stenosis Area Biochemical Biological Biological Markers Bioprosthesis device Cardiology Cardiovascular Diseases Cardiovascular system Chronology Citric Acid Cycle Clinical Clinical Investigator Clinical Research Clinical Trials Code Collection Consensus Data Data Sources Decision Making Energy Metabolism Enrollment Environment Epidemiology Etiology Faculty Funding Goals Health Healthcare Heterogeneity Human Impairment Individual Internal Medicine International Israel K-Series Research Career Programs Knowledge Lead Link Longevity Machine Learning Measures Mediating Medical Medical center Medicare Medicine Mentors Mentorship Methodology Operative Surgical Procedures Outcome Outcomes Research Patient Care Patients Persons Phenotype Physician Executives Physicians Physiological Population Procedures Prospective cohort Proteomics Provider Public Health Schools Quality of life Randomized Clinical Trials Recovery Registries Research Research Personnel Risk Risk Factors Scientist Selection for Treatments Stroke Subgroup Syndrome Techniques Time Training Treatment outcome United States National Institutes of Health Work administrative database adverse event risk adverse outcome aortic valve replacement base comorbidity end of life frailty health data health service use heart imaging high risk improved individual variation insight medical schools member metabolomics mid-career faculty minimally invasive molecular phenotype mortality new technology novel novel marker optimal treatments patient oriented research personalized medicine predictive modeling professor programs prospective surgical risk treatment effect treatment optimization treatment response

项目摘要

PROJECT SUMMARY Candidate: Dr. Strom received an MD from Harvard Medical School (HMS), and has completed clinical training in internal medicine (MGH), cardiology (BIDMC), and non-invasive cardiac imaging (BIDMC). Additionally, he completed an MSc in Epidemiology program at the Harvard T.H. Chan School of Public Health, in May, 2018. He is now a junior faculty member at BIDMC with 75% protected time to conduct clinical research. Through this proposed 5-year program, Dr. Strom will pursue additional training in advanced prediction modeling, machine learning, patient-oriented research, and metabolomics. The candidate’s long- term goal is to become an R01-funded investigator in the area of applied outcomes research. Environment: The candidate will be mentored by Robert W. Yeh (Primary Mentor), Associate Professor of Medicine at HMS and Director of the Smith Center for Outcomes Research in Cardiology, Robert E. Gerszten (Co-Mentor), Professor of Medicine at HMS and Chief of Cardiovascular Medicine at BIDMC, and Changyu Shen (Co-Mentor), upcoming Associate Professor of Medicine at HMS and Lead Biostatistician for the Smith Center. Dr. Yeh has a track record of leading practice-changing studies and successful mentorship of clinician investigators. Dr. Gerszten is an internationally recognized expert in molecular phenotyping of cardiovascular diseases using metabolomics and proteomics and has mentored several K-award and R01 funded clinical investigators. Dr. Shen has a long track record of NIH funding, expertise in evaluating heterogeneity of treatment effect in cardiovascular diseases, and has mentored multiple prior trainees. Research: The optimal therapy for a given individual with aortic stenosis remains uncertain. This proposal seeks to define the clinical and biologic components of frailty that modify risk after aortic valve replacement (AVR) and alter treatment benefit. For Aims 1-2, we will leverage the unique linkage of Medicare data to the US CoreValve Pivotal trials, a collection of clinical trials that randomized individuals with severe aortic stenosis to transcatheter AVR (TAVR) with a self-expanding bioprosthesis vs. surgical AVR (SAVR). In Aim 1, we will we will identify which variables, related to in-person assessments of frailty and candidate frailty codes, best predict adverse outcomes after AVR. In Aim 2, we will identify if novel variables identified in Aim 1, identify a heterogeneous treatment response in individuals undergoing AVR. In Aim 3, we will prospectively enroll patients undergoing TAVR at BIDMC with concurrent frailty phenotyping to identify whether metabolites associated with longevity correlate with frailty and predict adverse outcomes, independent of age and comorbidities. The research will identify the mechanisms by which frailty confers adverse risk and differential treatment benefit in AVR, providing insights that may personalize treatment selection and improve patient care.

项目摘要候选人：Strom博士从哈佛医学院（HMS）获得了医学博士学位，并已完成临床内科培训（MGH），心脏病学（BIDMC）和非侵入性心脏成像（BIDMC）。此外，他在哈佛T.H.完成了一项流行病学计划硕士学位。陈公共卫生学院， 2018年5月。他现在是BIDMC的初级教职员工，有75％的保护时间进行临床研究。通过此拟议的5年计划，Strom博士将在高级中进行其他培训预测建模，机器学习，面向患者的研究和代谢组学。候选人的长期术语目标是成为应用结果研究领域的R01资助的研究者。环境：候选人将由Robert W. Yeh（主要导师）考虑 HMS的医学和史密斯史密斯成果研究中心心脏病学中心主任，罗伯特·E·格斯茨（Co-Encortor），HMS医学教授，BIDMC的心血管医学主任和Changyu Shen（Co-Centor），即将在HMS的医学副教授，史密斯的主导生物统计学家中心。 Yeh博士在改变领先的实践研究和成功的临床心态方面有记录调查人员。 Gerszten博士是心血管分子表型的国际认可的专家使用代谢组学和蛋白质组学的疾病已被修复了几种K-勇敢和R01基本临床调查人员。 Shen博士拥有NIH资金的悠久记录，评估异质性的专业知识心血管疾病的治疗效果，并指导了多个先前的学员。研究：为特定患者患有主动脉狭窄的人的最佳疗法尚不确定。这个建议旨在定义脆弱的临床和生物学成分，以修改主动脉瓣置换后的风险（AVR）和改变治疗益处。对于AIMS 1-2，我们将利用Medicare数据的独特链接到美国Corevalve Pivotal试验，这是一系列临床试验，该试验随机患有严重主动脉狭窄用自扩展的生物植被与手术AVR（SAVR）进行自膨胀的生物植被（TAVR）。在AIM 1中，我们将我们将确定哪些变量，与脆弱和候选脆弱代码的面对面评估有关，最好预测AVR后的不良结果。在AIM 2中，我们将确定是否在AIM 1中识别出新的变量，确定一个接受AVR的个体的异质治疗反应。在AIM 3中，我们可能会注册在BIDMC接受TAVR的患者并发脆弱的表型，以确定代谢物是否是代谢物与寿命相关的与脆弱相关并预测不良后果，独立于年龄和合并症。该研究将确定脆弱供认不利风险和差异的机制 AVR的治疗益处，提供可以个性化治疗选择并改善患者护理的见解。