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 Margaret C. Fang（医学博士、公共卫生硕士）的以患者为导向的研究计划和职业发展，她是加州大学旧金山分校 (UCSF) 接受过奖学金培训的学术住院医生。方博士的总体职业目标是优化老年房颤患者的中风预防。她将制定一项研究计划，探索与心房颤动相关的中风和出血的临床和生物学危险因素，确定抗凝剂的最佳使用方法来预防心房颤动相关的中风，将注意力集中在最佳抗凝治疗管理的社会和行为障碍上，并测试旨在改善老年患者抗凝治疗方面临床决策的干预措施。职业发展计划：方博士将在 5 年奖励期内接受正式的教学培训并进行指导性临床研究。教学培训将包括结果评估、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社会学和生物学方面的课程和教程。她将通过参加加州大学旧金山分校核心老年病学课程获得临床老年病学培训。由加州大学旧金山分校老年病学主任兼她的首席导师 Seth Landefeld 博士领导的高级研究人员咨询委员会将监督方博士职业发展的各个方面。研究计划：本研究申请的目的是 (1) 确定高龄如何影响华法林控制和华法林不良结果； (2) 评估功能衰退、跌倒风险和认知障碍是否会导致华法林治疗结果更差； (3) 开发并试点测试一种决策工具，帮助临床医生比较为患有房颤的老年患者开出华法林处方的风险和益处。这些目标将通过3个项目来实现。在项目 1 中，Fang 博士将分析 ATRIA 队列中 13,559 名房颤患者的数据，以确定特定年龄的发生率、危险因素以及华法林相关出血和华法林控制的结果。在项目 2 中，方博士将召集一群患有心房颤动的虚弱社区老年人，研究虚弱与华法林控制和结果之间的关系。在项目3中，方博士将开发一种临床决策工具，结合前两项研究获得的数据，帮助临床医生决定老年房颤患者抗血栓治疗的最佳选择。然后，该决策工具将在加州大学旧金山分校护理房颤患者的临床医生中进行试点测试。这些项目将共同提供实践经验，并为未来的研究奠定基础，这些研究旨在提高老年房颤患者抗凝药物的安全性和使用。