Treatment Endpoints in Acute Decompensated Heart Failure

急性失代偿性心力衰竭的治疗终点

基本信息

批准号：
7531959
负责人：
SEAN PATRICK COLLINS
金额：
$ 16.34万
依托单位：
UNIVERSITY OF CINCINNATI
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7531959
关键词：
Accident and Emergency department Acute Admission activity Adverse event Aftercare Behavioral Budgets Caring Clinical Clinical Data Clinical Investigator Clinical Research Cohort Studies Complement Complex Consumption Coronary Coronary Arteriosclerosis Coronary Artery Bypass Data Decision Making Decision Modeling Development Diagnosis Disease Economic Burden Emergency Situation End Point Enrollment Environment Event Fellowship Functional disorder Future Goals Guidelines Health Health behavior Healthcare Healthcare Systems Heart failure Home environment Hospital Mortality Hospitalization Hospitals Hour Incidence Individual Inpatients Intervention Interview Knowledge Laboratories Length of Stay Measures Medical Mentors Methodology Modeling Morbidity - disease rate Natriuretic Peptides Outcome Outcomes Research Parents Patient Care Patient Discharge Patients Physicians Physiological Population Process Qualifying Quality of Care Rate Research Research Methodology Research Personnel Resources Risk Risk Behaviors Risk Marker Science Stratification Targeted Research Testing Therapeutic Time Uncertainty Work abstracting base cohort cost cost effectiveness day experience improved innovation insight mathematical model mortality practical application programs prospective recidivism response social success

项目摘要

DESCRIPTION (provided by applicant): A fundamental question faced by physicians treating acute decompensated heart failure (ADHF) is 'When has treatment worked sufficiently for safe discharge, and who requires further treatment?' Patients with ADHF have a high incidence of morbidity and mortality. Current guidelines for emergency department (ED) and hospital disposition of patients with ADHF are based on limited empirical evidence. This creates clinical uncertainty regarding disposition, leads to prolonged hospitalizations, higher costs and increased resource consumption. Conducting a project to answer this question, in combination with carefully planned didactics and mentoring from distinguished researchers, will allow me to develop as an independent clinical investigator with a primary focus on decision making in patients with ADHF. The ED is the portal of entry for the majority of ADHF admissions and presents fertile ground for prospectively studying decision making. My specific aims are: 1) to further develop knowledge in clinical research, advanced modeling, and decision sciences to advance my development as an independent clinical investigator and 2) to develop a prediction rule from readily available clinical data that helps physicians identify ADHF patients for whom early discharge from the ED and hospital is safe after treatment is initiated. In recognition of the importance of the ED in ADHF care, the NHLBI is supporting our observational cohort study of 1800 ED patients to develop a prediction rule for initial risk-stratification (STRATIFY- 1R01HL088459). To complete my aim, I will collect additional data on a subset of 500 patients from STRATIFY whose baseline data is collected within 1 hour of ED therapy. In addition to the baseline data from STRATIFY, the current proposal will collect clinical and laboratory data 2-4 hours, 12-24 hours and 96 hours after treatment is begun. We will also interview patients to measure social and behavioral variables. We will use this additional data to develop a second prediction rule to assist physicians in identifying patients safe for early ED and hospital discharge after therapy is begun. This project is an ideal vehicle for practical application of didactic knowledge gained, offers an intensive clinical research experience, and promises to generate extensive preliminary data to fully expand a long-term research program. My clinical research, didactic program and advanced biostatistical and modeling coursework will be supervised by a highly qualified, multi-disciplinary team of talented individuals, Building from my completed Outcomes Research fellowship and previous research experience, this proposal will allow me to mature as a clinical investigator, develop a prediction rule for decision making in ADHF, and engender evidence- based research in a disease process with tremendous healthcare system implications. (End of Abstract)

描述（由申请人提供）：医生治疗急性代偿性心力衰竭（ADHF）面临的一个基本问题是“何时治疗足以确保安全出院，谁需要进一步治疗？” ADHF患者发病率和死亡率很高。 ADHF患者的急诊科（ED）和医院处置的当前指南基于有限的经验证据。这会导致有关处置的临床不确定性，导致住院时间延长，成本更高和资源消耗增加。进行一个项目以回答这个问题，再加上精心计划的教学和杰出研究人员的指导，将使我能够发展为独立的临床研究者，主要关注ADHF患者的决策。 ED是大多数ADHF入学的入口门户，并为前瞻性研究决策提供了沃土。我的具体目的是：1）进一步发展临床研究，高级建模和决策科学方面的知识，以促进我作为独立临床研究者的发展，2）从随时可用的临床数据中制定预测规则，这些数据可帮助医生识别ADHF患者，这些患者在接受治疗后安全地从ED和医院提供了早期出院。为了认识到ED在ADHF护理中的重要性，NHLBI支持我们对1800名ED患者的观察队列研究，以制定初始风险分层的预测规则（Stratify-1R01HL088459）。为了完成我的目标，我将收集有关500例基线数据在ED治疗后1小时收集基线数据的500例患者的其他数据。除了来自Stratify的基线数据外，当前的建议还将在治疗后2-4小时零2-4小时零96小时收集临床和实验室数据。我们还将采访患者以衡量社会和行为变量。我们将使用这些其他数据制定第二个预测规则，以帮助医生确定患者的早期ED和治疗后的医院出院。该项目是实践应用教学知识，提供丰富的临床研究经验的理想工具，并有望生成广泛的初步数据，以充分扩大长期研究计划。我的临床研究，教学课程以及高级生物统计学和建模课程将由一个高度合格的多学科团队组成的才华横溢的人，从我完成的成果研究奖学金和以前的研究经验中建立，这项建议将使我能够成熟作为临床研究者，并在ADHF和基于证据的研究过程中制定预测规则，并进行了良好的研究。（抽象的结尾）