Acute Decompensated Heart Failure: Treatment Timing and Effects on Outcomes

急性失代偿性心力衰竭：治疗时机和对结果的影响

• 批准号: 8127875
• 负责人: Chad Eric Darling
• 金额: $ 13.37万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8127875
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; American; Basic Science; Biometry; Cardiovascular system; Caring; Characteristics; Clinical; Clinical Management; Clinical Research; Clinical Trials; Collaborations; Communities; Community Hospitals; Complement; Coupled; Data; Data Collection; Decision Making; Development Plans; Diagnosis; Diuresis; Diuretics; Dose; Dyspnea; Early treatment; Educational process of instructing; Emergency Medicine; Enrollment; Ethics; Expert Opinion; Floor; Funding; Goals; Grant; Growth; Healthcare Systems; Heart failure; Hospitalization; Hospitals; Hour; Inpatients; Institution; Intratracheal Intubation; K-Series Research Career Programs; Learning; Length; Length of Stay; Manuscripts; Massachusetts; Medical center; Mentors; Mining; Monitor; Morbidity - disease rate; Observational Study; Outcome; Outpatients; Patient Care; Patients; Pharmaceutical Preparations; Phase; Physicians; Preparation; Productivity; Quality of Care; Renal function; Research; Research Design; Research Personnel; Research Proposals; Resources; Staging; Students; Symptoms; Teaching Hospitals; Time; Training; Training Programs; Uncertainty; United States; United States National Institutes of Health; Visual; Work; Writing; analog; base; biomedical informatics; cardiovascular disorder epidemiology; career; career development; clinical epidemiology; cost; design; experience; high risk; improved; indexing; insight; interest; medical schools; mortality; primary outcome; programs; prospective; randomized trial; response; secondary outcome; skills; tertiary care; tool

DESCRIPTION (provided by applicant): I have a longstanding interest in cardiovascular research, and I have been involved in basic science, translational, and clinical projects. I am applying for this Career Development Award (CDA) in an effort to acquire additional training so that I can independently design and conduct meaningful clinical research. A key short-term goal of mine is to use the skills obtained from my proposed training program to develop collaborative research efforts both within and outside my institution. I have found it enjoyable to work with other researchers as I find such collaborations stimulate new research ideas and provide for additional learning opportunities. In the nearterm I also hope to increase my research productivity and writing skills by working with my mentor and his research group. My long-term goals are to become a leader in clinical research for my Department and use those skills to build productive research relationships between Emergency Departments (ED) in my region and to be able to mentor others interested in research careers. I believe that Emergency Medicine provides a wealth of potential research opportunities but lacks experienced leaders and mentors that can develop and guide clinical research proposals. The career development plan I am proposing is multifaceted. At the core is obtaining didactic training in the UMass Medical School Masters in Clinical Investigation Program. This program is directed by my mentor and focuses on coursework that is tailored specifically to provide students with the tools they need to become independent investigators. The courses cover clinical epidemiology, biostatistics, biomedical informatics, ethics, and the design and conduct of clinical research. My growth as a clinical researcher will also depend on the guidance of my mentor, co-mentor, and advisors. Dr. Robert Goldberg will serve as my primary mentor, and Dr. Theo Meyer as a co-mentor. Dr's. Goldberg and Meyer complement each other with regards to the expertise they bring to this proposal. Dr. Goldberg provides particular expertise with regards to study design, cardiovascular epidemiology, grant writing and manuscript preparation, and has a long track-record of obtaining NIH funding. Dr. Meyer is a practicing cardiologist with substantial expertise in the clinical management of heart failure (HF) as well as HF research. The primary aim of this proposal focuses on studying the effect that the timing of pharmacologic treatment for Acute Decompensated Heart Failure (ADHF) in the ED has on short term outcomes. I believe this is an important question not just because uncertainty exists with regards to how best to treat ADHF, but also because the quality of care provided is likely impacted by this uncertainty. The outcomes I am interested in are all related to the index hospitalization and include such things as the type of admission (ICU vs. floor), length of stay, and improvement in symptoms over 24 hours (via Visual Analog Scale Scores). These aims will be addressed both by collecting multicenter retrospective data and through prospective enrollment of ADHF patients in the ED. This approach will allow me to address my aims in multiple ED settings including teaching and community hospitals. Project Narrative: Approximately 5.3 million Americans presently suffer from heart failure (HF) and upwards of 700,000 new cases occur annually in the United States. Moreover, three-quarters of all Hospitalizations related to Acute Decompensated Heart Failure (ADHF) are initially seen in the Emergency Department (ED). Difficulties in making an accurate diagnosis, coupled with undefined acute treatment goals, make caring for high-risk ADHF patients in the ED a challenge. The significant morbidity and associated hospital and outpatient costs related to HF are estimated to exceed 30 billion dollars annually. Given this burden that HF places on the healthcare system, it has been recommended that more studies be done to investigate how to provide efficient care to these patients. Should more resources be directed at the care of ED patients with potential ADHF? How much do short-term outcomes such as length of stay and need for ICU care depend on the treatment decisions made in the ED? To address such questions, this study will attempt to gain insight into the initial ED care of ADHF in an attempt to understand what impact early treatment decisions have on clinical outcomes.

描述（由申请人提供）：我对心血管研究有着长期的兴趣，我参与了基础科学，转化和临床项目。我申请这个职业发展奖（CDA）是为了获得额外的培训，以便我能够独立设计和进行有意义的临床研究。我的一个关键的短期目标是利用从我提出的培训计划中获得的技能，在我的机构内外开展合作研究。我发现与其他研究人员合作是一件令人愉快的事情，因为我发现这种合作激发了新的研究思路，并提供了额外的学习机会。在短期内，我也希望通过与我的导师和他的研究小组合作来提高我的研究效率和写作技巧。我的长期目标是成为我所在部门临床研究的领导者，并利用这些技能在我所在地区的急诊科（艾德）之间建立富有成效的研究关系，并能够指导其他对研究事业感兴趣的人。我相信急诊医学提供了丰富的潜在研究机会，但缺乏经验丰富的领导者和导师，可以制定和指导临床研究建议。 我提出的职业发展计划是多方面的。核心是获得教学 麻省大学医学院临床研究硕士课程。这个程序是 由我的导师指导，专注于专门为学生提供的课程 成为独立调查员所需的工具。课程包括临床流行病学，生物统计学，生物医学信息学，伦理学以及临床研究的设计和实施。作为一名临床研究人员，我的成长也将取决于我的导师，共同导师和顾问的指导。罗伯特·戈德堡博士将担任我的主要导师，西奥·迈耶博士将担任我的共同导师。医生的。Goldberg和Meyer在他们为这项提案带来的专业知识方面相互补充。Goldberg博士在研究设计、心血管流行病学、资助撰写和手稿准备方面提供了特殊的专业知识，并有获得NIH资助的长期记录。Meyer博士是一位执业心脏病专家，在心力衰竭（HF）的临床管理和HF研究方面具有丰富的专业知识。 这项建议的主要目的是研究药理学的时间选择的影响。 在艾德中治疗急性失代偿性心力衰竭（ADHF）没有短期结果。我认为这是一个重要的问题，不仅因为如何最好地治疗ADHF存在不确定性，而且因为提供的护理质量可能受到这种不确定性的影响。我感兴趣的结果都与指数住院有关，包括入院类型（ICU与楼层）、住院时间和24小时内症状的改善（通过视觉模拟量表评分）。这些目标将通过收集多中心回顾性数据和在ED前瞻性招募ADHF患者来实现。这种方法将使我能够在多个艾德环境（包括教学和社区医院）中实现我的目标。 项目叙述：目前约有530万美国人患有心力衰竭（HF），并且在美国每年发生超过700，000例新病例。此外，四分之三的 与急性失代偿性心力衰竭（ADHF）相关的住院最初见于急诊科（艾德）。准确诊断的困难，加上不确定的急性治疗目标，使得在艾德护理高危ADHF患者成为一项挑战。与HF相关的显著发病率和相关的住院和门诊费用估计每年超过300亿美元。鉴于HF给医疗保健系统带来的负担，建议进行更多研究，以研究如何为这些患者提供有效的护理。是否应该将更多的资源用于艾德患者的护理？短期结果（如住院时间和ICU护理需求）在多大程度上取决于艾德的治疗决定？为了解决这些问题，本研究将试图深入了解ADHF的初始艾德护理，以了解早期治疗决策对临床结局的影响。