Trends in and Outcomes of Medication Use in Older Adults

老年人用药趋势和结果

• 批准号: 6325421
• 负责人: Bruce M Psaty
• 金额: $ 53.48万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-01 至 2005-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6325421
• 关键词: ACE inhibitors; aging; alpha antiadrenergic agent; antihypercholesterolemic agent; antihypertensive agents; atrial fibrillation; beta antiadrenergic agent; cardiovascular agents; cardiovascular disorder; cardiovascular disorder chemotherapy; cardiovascular disorder epidemiology; clinical research; cognition; congestive heart failure; coronary disorder; human mortality; human old age (65+); human subject; human therapy evaluation; outcomes research; stroke; warfarin

This proposal, the 2nd revision of a competing continuation last reviewed in March 2000, is an ancillary study to the Cardiovascular Health Study (CHS), a cohort study of risk factors for coronary disease and stroke in 5888 older adults. This revision addresses questions such confounding and interpretation raised by the Study Section. In CHS, medical conditions are well characterized, and participants are followed closely for events. CHS clinic visits, where medication data had been collected, ended in 1999, and the NHLBI plans to provide full support only for events follow-up for an additional 5 years. This project provides support to 4 Field Centers to continue to collect medication data by telephone interview and to CHS scientists to continue analyses of these data. In a pilot study of 74 subjects, agreement between in-clinic and telephone- interview medication inventories was excellent. The purpose is to assess use of cardiovascular medications and their associations with outcomes among older adults. To date, the project is associated with 26 publications and 7 presentations. The aims, which focus on the use of cardiovascular medications and their association with events, are consistent with PA99-097 entitled, "Diversity in Medication Use and Outcomes in Aging Populations." One innovative feature of this study is the age of the cohort. At baseline in 1989-90, the mean age of the CHS cohort was 72.8 years, and as of Oct 1999, the mean age of the survivors was 81.2 years: 2290 (55.9 percent) of the 4095 surviving CHS participants are 80 years of age or older. Over the last several decades, the results of randomized clinical trials and meta-analyses have helped to define optimal care for patients with cardiovascular disease or with risk factors for cardiovascular disease. Guidelines have been formulated for the care of patients with coronary disease or with risk factors such as elevated levels of cholesterol or blood pressure. But information about the implementation of guidelines or the effect of clinical trials on practice patterns is often lacking for older adults; and we also lack information about the efficacy and safety of most medications for older adults, especially the oldest old, who are the fastest growing segment of the US population. The aim of this project is to describe the use of various cardiovascular medications and their association with outcomes among older adults. The project has good to excellent power for a number of hypotheses, including: the use of ACE inhibitors and beta- blockers in subjects with heart failure or coronary disease and their association with total mortality; the use of warfarin in patients with atrial fibrillation and their association with stroke or death; the use of blood pressure and lipid lowering medications and their association with cardiovascular events and cognitive function.

该提案是对2000年3月上次审查的竞争延续的第二次修订，是对心血管健康研究（CHS）的辅助研究，这是对5888名老年人的冠状动脉疾病和中风危险因素的队列研究。此修订解决了研究部分提出的混杂和解释问题。 在CHS中，医疗状况的特征很好，并且参与者受到事件的紧密遵循。 CHS诊所就诊，该诊所已收集到1999年结束，NHLBI计划仅对事件的随访提供全额支持5年。该项目为4个现场中心提供了支持，以继续通过电话访谈收集药物数据，并向CHS科学家继续对这些数据进行分析。 在一项对74名受试者的试点研究中，临床和电话访谈药物清单之间的一致性非常好。 目的是评估心血管药物的使用及其与老年人的结局的使用。 迄今为止，该项目与26个出版物和7个演讲有关。该目标侧重于使用心血管药物及其与事件的关联，与PA99-097一致，标题为“药物使用的多样性和衰老人群的结果”。这项研究的一个创新特征是同类年龄。在1989 - 90年的基线时，CHS队列的平均年龄为72.8岁，截至1999年10月，幸存者的平均年龄为81.2岁：4095个幸存的CHS参与者中的2290（55.9％）为80岁或以上。 在过去的几十年中，随机临床试验和荟萃分析的结果有助于为心血管疾病患者或心血管疾病的危险因素定义最佳护理。已经制定了指南，以护理冠状动脉疾病患者或诸如胆固醇或血压升高的危险因素。 但是，对于老年人，通常缺乏有关指南的实施或临床试验对实践模式的影响的信息；而且我们还缺乏有关大多数药物对老年人的疗效和安全性的信息，尤其是老年人，他们是美国人口中增长最快的部分。 该项目的目的是描述使用各种心血管药物的使用及其与老年人的结局相关联。 该项目具有许多假设的良好能力，包括：在患有心力衰竭或冠状动脉疾病的受试者中使用ACE抑制剂和β受体阻滞剂，及其与总死亡率的关联；华法林在房颤患者中使用及其与中风或死亡的关联；血压和脂质降低药物的使用及其与心血管事件和认知功能的关联。