Atrial fibrillation, functional decline, and arrhythmia detection in older adults

描述（由申请人提供）：房颤（AF）具有严重的发病率和死亡率，主要是一种高龄疾病。亚临床AF导致老年人衰弱的结局。关于AF与体能和功能状态的关系的研究非常有限，这些都是与年龄相关的不良下降的既定指标。我们的中心假设是，AF对老年人的体能和功能状态下降有显著影响。我们的长期目标是双重的：研究AF如何加剧功能限制，并最终确定早期识别亚临床AF是否可以减轻其对这些过程的影响。本研究将在birthday健康、衰老和身体成分（健康ABC）研究中检查AF与功能评估的横截面和前瞻性关系，该研究包括3，075名功能良好的老年人（70-79岁）。作为补充目的，这些研究将开发一项创新的试点和可行性研究，在波士顿大学老年病家庭护理计划（平均年龄84.2岁，54%为非洲裔美国人）中选择的一组居家老年人中检查亚临床AF。目标1将在基线检查和第4年、第6年、第8年和第10年检查健康ABC中AF与体能和功能状态的横截面关系。目标2将确定AF与健康ABC检查中身体表现和功能状态指标纵向变化的前瞻性关系。目标3将在居家老年人（n=100）中使用一种不显眼的7天心律监测仪，建立检测亚临床AF的试点和可行性数据。 房颤和老年流行病学确定AF与年龄相关的身体表现和功能状态下降的关系对于早期发现和治疗AF以预防这种下降具有重要意义。在居家、体弱的老年人中检测亚临床AF可能会促使循证干预（即卒中预防），从而降低与AF相关的严重发病率。这些调查将有助于扩大研究，以检查更大队列的居家老年人中亚临床AF的患病率，并确定其与不良结局的前瞻性关系。在波士顿克劳德佩珀老年美国人独立中心的老年医学研究和AF和整合的关键指导将加强拟议的调查。9/27/2012

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) conveys profound morbidity and mortality and is principally a disease of advanced age. Subclinical AF results in debilitating outcomes in older adults. There has been markedly limited study of the relation of AF to physical performance and functional status, established metrics of adverse age-related decline. Our central hypothesis is that AF contributes significantly to declining physical performance and functional status in older adults. Our long-term goals are two-fold: to examine how AF exacerbates functional limitations, and ultimately to determine if earlier identification of subclinical AF can mitigate its impact on such processes. The present investigations will examine the cross-sectional and prospective relations of AF to functional assessments in the biracial Health, Aging, and Body Composition (Health ABC) Study, consisting in 3,075 well-functioning older adults (70-79 years). As a complementary aim, the investigations will develop an innovative pilot and feasibility study examining subclinical AF in a cohort of home-bound older adults selected from the Boston University Geriatrics Home-Care Program (mean age 84.2, 54% African American). Aim 1 will examine the cross-sectional relations of AF to physical performance and functional status in Health ABC at the baseline exam and years 4, 6, 8 and 10. Aim 2 will determine the prospective relation of AF to longitudinal changes in measures of physical performance and functional status across Health ABC exams. Aim 3 will employ an unobtrusive 7-day cardiac rhythm monitor in home-bound older adults (n=100), establishing pilot and feasibility data for detection of subclinical AF. The proposed studies will fill important gaps in AF and geriatric epidemiology. Determining the relation of AF to age-related decline in physical performance and functional status has important implications for earlier detection and treatment of AF to prevent such decline. Detecting subclinical AF in home-bound, frail older adults may prompt evidence-based interventions (i.e. stroke prevention) that reduce the severe morbidity associated with AF. These investigations will contribute towards an expanded study to examine the prevalence of subclinical AF in a larger cohort of home-bound older adults and determine its prospective relation to adverse outcomes. Key mentoring in geriatric research and AF and integration in the Boston Claude Pepper Older Americans Independence Center will enhance the proposed investigations. 9/27/2012