Heart Failure in the Community

社区心力衰竭

• 批准号: 7000348
• 负责人: Veronique Lee Roger
• 金额: $ 63.96万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-01-15 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7000348
• 关键词: blood chemistry; cardiovascular disorder epidemiology; cardiovascular disorder risk; clinical research; community; comorbidity; congestive heart failure; coronary disorder; diabetes mellitus; disease /disorder etiology; echocardiography; heart disorder diagnosis; heart failure; hospital utilization; human population study; human subject; hypertension; medical records; obesity; outcomes research

DESCRIPTION (provided by applicant): Heart failure (HF) is designated as an emerging epidemic. Yet, it is not fully characterized. Most data, derived from hospital discharges, cannot measure incidence, have uncertain validity and cannot capture the full burden of HF because of the shift towards outpatient care. Regarding its etiology, the respective role of hypertension and coronary heart disease (CHD) is controversial. Moreover, the prevalence of obesity and diabetes mellitus is increasing, both conditions linked to HF via several mechanisms such that their contribution to HF could conceivably be increasing but remains to be examined. Finally, while the existence of diastolic HF is recognized, its diagnosis is exclusionary based on symptoms of HF in the absence of LV systolic dysfunction. This approach is unsatisfactory, thus the contribution of DHF to HF remains contentious. These striking gaps in knowledge underscore the necessity of a rigorous investigation of the HF epidemic. Through surveillance of the Olmsted County community, we demonstrated the postponement of CHD towards older ages and the decline over time in the severity of hospitalized MI and the incidence of HF after MI. This implies that, if CHD is the main cause of HF, HF should be postponed towards older ages and its incidence rate relatively stable. During the same period, preliminary findings on HF surveillance suggest that the incidence of first clinical diagnosis of HF may not be increasing as much as implied by hospital discharges and that adverse trends may be occurring preferentially among younger ages. These data from the same community are challenging to reconcile with the concept of an ongoing major contribution of CHD to an epidemic of HF, thereby underscoring the need to rigorously study the epidemiology of HF, which is the focus of this application. We propose 3 specific aims and a community surveillance approach, integrated with our ongoing work on CHD surveillance to investigate the HF epidemic in Olmsted County by characterizing its magnitude and determinants and studying prospectively the contribution of DHF. Aim 1 will estimate the secular trends in the incidence and in the outcome of validated HF to test the hypotheses that there has been an increase in the incidence of HF, which differs by age and sex and that the survival of HF improved while hospitalization for HF has increased. Aim 2 will use a case-control approach to characterize the etiology of HF and its changes over time to test the hypotheses that CHD and hypertension confer an excess risk of HF, the magnitude of which is declining over time, that obesity and diabetes mellitus confer an excess risk of HF the magnitude of which is increasing and that the population attributable risk of CHD and hypertension for HF is declining, while that of obesity and diabetes mellitus is increasing over time. Aim 3 will prospectively characterize the contribution of DHF to HF using brain natriuretic peptide (BNP) among persons with HF and define the prognostic value of BNP in all cases of HF. Thus, the completion of these aims will provide important insights into the epidemiology of HF.

描述（由申请人提供）：心力衰竭（HF）被指定为一种新兴流行病。然而，它并没有被充分描述。大多数数据来自出院，无法测量发病率，有效性不确定，并且由于转向门诊治疗，无法捕获HF的全部负担。关于其病因，高血压和冠心病（CHD）各自的作用是有争议的。此外，肥胖和糖尿病的患病率正在增加，这两种疾病通过几种机制与HF相关，因此可以想象它们对HF的贡献正在增加，但仍有待研究。最后，虽然舒张期HF的存在是公认的，它的诊断是排除性的基础上的HF症状的LV收缩功能不全。这种方法并不令人满意，因此DHF对HF的贡献仍然存在争议。这些知识上的显著差距强调了对HF流行进行严格调查的必要性。通过对奥姆斯特德县社区的监测，我们证明了CHD向老年人的推迟，住院MI的严重程度和MI后HF的发生率随时间的推移而下降。这意味着，如果CHD是HF的主要原因，HF应推迟到老年，其发病率相对稳定。在同一时期，HF监测的初步结果表明，HF首次临床诊断的发生率可能没有像出院时那样增加，并且不良趋势可能优先发生在年轻人中。来自同一社区的这些数据很难与CHD对HF流行的持续主要贡献的概念相一致，从而强调需要严格研究HF的流行病学，这是本申请的重点。我们提出了3个具体目标和社区监测方法，结合我们正在进行的冠心病监测工作，调查在奥姆斯特德县HF流行的特点，其规模和决定因素，并前瞻性地研究DHF的贡献。目的1将估计经验证的HF的发病率和结局的长期趋势，以检验HF发病率增加（因年龄和性别而异）以及HF生存率改善（因HF住院治疗增加）的假设。目的2将使用病例对照方法描述HF的病因及其随时间的变化，以检验以下假设：CHD和高血压导致HF的过度风险，其程度随时间下降，肥胖和糖尿病导致HF的过度风险，其程度增加，以及CHD和高血压导致HF的人群归因风险正在下降，而肥胖症和糖尿病的发病率随着时间的推移而增加。目的3将使用脑利钠肽（BNP）在HF患者中前瞻性地描述DHF对HF的贡献，并确定BNP在所有HF病例中的预后价值。因此，这些目标的完成将为HF的流行病学提供重要的见解。