Risks of Warfarin for Elders with Atrial Fibrillation

华法林对患有心房颤动的老年人的风险

• 批准号: 7151712
• 负责人: MARGARET C. FANG
• 金额: $ 17.5万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7151712
• 关键词: adult human (21+); age difference; aging; anticoagulants; atrial fibrillation; clinical research; cognition; disease /disorder proneness /risk; drug adverse effect; functional ability; health care service evaluation; health services research tag; hemorrhage; human data; information systems; medical records; outcomes research; patient care planning; patient oriented research; stroke; time resolved data; warfarin

DESCRIPTION (provided by applicant): OVERVIEW: The purpose of this application is to support the patient-oriented research program and career development of Margaret C. Fang, MD, MPH, a fellowship-trained academic hospitalist at the University of California, San Francisco (UCSF). Dr. Fang's overall career goal is to optimize stroke prevention in older patients with atrial fibrillation. She will develop a research program that will explore clinical and biological risk factors for stroke and hemorrhage associated with atrial fibrillation, identify the optimal use of anticoagulants to prevent atrial Fibrillation-related stroke, direct attention towards social and behavioral barriers to optimal anticoagulant management, and test interventions directed at improving clinical decision-making in regards to anticoagulating the oldest patients. CAREER DEVELOPMENT PLAN: Dr. Fang will undergo formal didactic training and conduct mentored clinical research over the 5 year award period. Didactic training will include coursework and tutorials in outcomes assessment, propensity score analysis, cost-effectiveness analysis, genetic epidemiology, functional status assessment, and the sociology and biology of aging. She will obtain training in clinical geriatrics through enrolling in the UCSF Core Geriatrics Curriculum. An advisory committee of senior investigators, led by Dr. Seth Landefeld, the Chief of Geriatrics at UCSF and her Principal Mentor, will oversee all aspects of Dr. Fang's career development. RESEARCH PLAN: The aims of this researchapplication are to (1) determine how advanced age affects warfarin control and poor outcomes from warfarin; (2) assess whether functional decline, fall-risk, and cognitive impairment lead to worse outcomes on warfarin; and (3) develop and pilot test a decision tool that helps Clinicians compare the risks and benefits of prescribing warfarin for older patients with atrial fibrillation. These aims will be accomplished through 3 projects. In Project 1, Dr. Fang will analyze data from the ATRIA cohort of 13,559 people with atrial fibrillation to determine age-specific rates, risk factors, and outcomes of warfarin-associated hemorrhage and warfarin control. In Project 2, Dr. Fang will assemble a cohort of frail community-dwelling elders with atrial fibrillation to study how frailty is associated with warfarin control and outcomes. In Project 3, Dr. Fang will develop a clinical decision tool, incorporating data obtained from the first two studies, to assist clinicians decide on the optimal choice of antithrombotic therapy for older patients with atrial fibrillation. This decision tool will then be pilot tested among clinicians caring for patients with atrial fibrillation at UCSF. Together, these projects will provide practical experience and form the basis for future studies that seek to improve the safety and use of anticoagulants in the oldest patients with atrial fibrillation.

描述（由申请人提供）：概述：本申请的目的是支持以患者为导向的研究计划和Margaret C. Fang，MD，MPH，MPH的职业发展，这是加利福尼亚大学旧金山分校（UCSF）的奖学金培训的学术医院主义者。方博士的整体职业目标是优化心房颤动老年患者的中风。她将制定一项研究计划，该计划将探索与房颤相关的中风和出血的临床和生物学风险因素，确定抗凝剂的最佳用途以防止与房颤相关的中风，直接关注社会和行为障碍，以对社会和行为障碍，以最佳的抗凝治疗和抗癌治疗以及对抗癌症的抗测试措施，以改善对抗药性的临床范围。职业发展计划：Fang博士将接受正式的教学培训，并在5年期间进行指导的临床研究。教学培训将在结果评估，倾向评分分析，成本效益分析，遗传流行病学，功能状态评估以及衰老的社会学和生物学方面包括课程和教程。她将通过参加UCSF核心老年医学课程来获得临床老年医学培训。由UCSF的老年医学总监Seth Landefeld博士和她的主要导师塞思·兰德菲尔德（Seth Landefeld）博士领导的高级调查员咨询委员会将监督方博士的职业发展的各个方面。研究计划：这项研究申请的目的是（1）确定高级年龄如何影响华法林的控制和不良的华法林结果； （2）评估功能下降，秋季风险和认知障碍是否导致华法林的结果较差； （3）开发和试点测试一种决策工具，可帮助临床医生比较为房颤的老年患者开处方华法林的风险和好处。这些目标将通过3个项目实现。在项目1中，Fang博士将分析13,559人心房颤动的心房队列的数据，以确定特定年龄的率，风险因素和与华法林相关的出血和华法林控制的结果。在项目2中，Fang博士将组装一批脆弱的社区居民长老，以心房颤动研究与华法林的控制和成果相关的脆弱性。在项目3中，Fang博士将开发一种临床决策工具，并结合了从前两项研究获得的数据，以帮助临床医生决定为心房颤动的老年患者选择抗血栓疗法的最佳选择。然后，该决策工具将在关心UCSF的心房颤动患者的临床医生中进行试验。这些项目将共同提供实践经验，并为未来的研究提供基础，以提高最古老的房颤患者的抗凝剂的安全和使用。