Impact of Comorbidity Dyads on Heart Failure Treatment in Older Persons

描述(由申请人提供)：多发病极大地增加了老年心衰患者住院和死亡的风险。某些慢性疾病在心力衰竭患者中尤其普遍，并使这些人面临更大的后续发病率和死亡率风险。慢性肺部疾病和慢性肾脏疾病尤其常见，在因心力衰竭住院的医疗保险受益人中，这些疾病是带来最高额外死亡风险的并存疾病之一。此应用程序响应RFA-AG-13-003(对患有多种慢性病的人的有效性、健康结果和成本进行比较的二次分析)。有机会研究常见治疗心力衰竭患者的有效性和安全性，这些患者属于某些高度流行的共病二联体：心力衰竭-慢性肺病和心力衰竭-慢性肾脏病。在国家心肺血液研究所(心力衰竭的管理和结果1RC1HL09939)的资助下，我们开发了一套丰富的临床数据集，以表征当代实践模式，并检查超过30,000名心衰患者的死亡率和住院率，其中近80%的患者年龄在65岁或以上。作为对RFA-AG-13-003的回应，我们提议的研究将利用这一现有数据集来解决关于重要的心力衰竭亚组以及这些高危患者与心力衰竭相关的治疗的有效性和安全性的紧迫知识空白，涉及住院和死亡。为了解决这些问题，我们经验丰富的研究团队将追求以下具体目标：(1)确定两大社区慢性心力衰竭患者队列的特征：心力衰竭-慢性肺病(n=12,000)和心力衰竭-慢性肾脏病(n=16,000)；(2)评估心力衰竭-慢性肺病二重病组患者使用β-受体阻滞剂治疗的临床有效性和安全性；(3)评价血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂(ARB)和醛固酮拮抗剂对心力衰竭-慢性肾脏病二联症患者的临床疗效和安全性。

DESCRIPTION (provided by applicant): Multimorbidity greatly increases the risk of hospitalization and mortality among older HF patients. Certain dyads of chronic medical conditions are particularly prevalent in HF patients and place these individuals at substantially greater risk of subsequent morbidity and mortality. Chronic lung disease and chronic kidney disease are especially common, and among Medicare beneficiaries hospitalized with HF, these conditions are among the comorbidities that confer the highest excess mortality risk. This application responds to RFA-AG-13-003 (Secondary Analyses of Comparative Effectiveness, Health Outcomes, and Costs in Persons with Multiple Chronic Conditions). An opportunity exists to study the effectiveness and safety of common treatments for patients with HF who fall into certain highly prevalent comorbidity dyad groups: HF-chronic lung disease and HF-chronic kidney disease. Under a grant from the National Heart, Lung, and Blood Institute (Management and Outcomes of Heart Failure 1RC1HL09939), we developed a rich, clinical data set to characterize contemporary practice patterns and examine rates of death and hospitalization in over 30,000 HF patients, with nearly 80% 65 years of age or older. In response to RFA-AG-13-003, our proposed study will take advantage of this existing data set to address pressing knowledge gaps about important HF subgroups and the effectiveness and safety of HF-related therapies in these high risk patients, with regard to hospitalization and death. To address these issues, our experienced research team will pursue the following specific aims: (1) to characterize two large, community-based cohorts of patients with important HF-chronic condition dyads: HF-chronic lung disease (n= >12,000) and HF-chronic kidney disease (n= ~16,000); (2) to assess the clinical effectiveness and safety associated with the use of beta-blocker therapy for patients in the HF-chronic lung disease dyad group; and (3) to assess the clinical effectiveness and safety associated with the use of ACE inhibitors/angiotensin II receptor blockers (ARBs) and aldosterone antagonists for patients in the HF-chronic kidney disease dyad group.