The Atrial Fibrillation - Factor Identification to Risk Modification Study in HD

心房颤动 - HD 风险调整研究的因素识别

• 批准号: 8517713
• 负责人: WOLFGANG CHRISTOPH WINKELMAYER
• 金额: $ 46.27万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517713
• 关键词: Adult; Affect; Age; Algorithms; American; Arrhythmia; Atrial Fibrillation; Berlin; Bioinformatics; Biometry; Blood Pressure; C-reactive protein; Calcium; Cardiovascular system; Caring; Catheters; Caucasoid Race; Cessation of life; Characteristics; Clinical; Comorbidity; Coronary heart disease; Data; Data Set; Databases; Deltastab; Diabetes Mellitus; Diagnosis; Dialysis patients; Dialysis procedure; Digestive System Disorders; Elderly; Electrocardiogram; Electrolytes; Electronic Health Record; End stage renal failure; Environment; Ethnic Origin; Excision; Funding; Health; Health Care Costs; Healthcare; Heart Atrium; Heart Rate; Heart Valve Diseases; Heart failure; Hematological Disease; Hemodialysis; Hemoglobin; Hispanics; Hormones; Hospitalization; Hypotension; Incidence; Institutes; Insurance; Intervention; Intervention Studies; Ischemic Stroke; Kidney; Kidney Diseases; Laboratories; Lead; Left; Life; Link; Liquid substance; Maintenance; Measurement; Measures; Medical Records; Medicare; Medicare claim; Methods; Mission; Modification; Morbidity - disease rate; Myocardial Infarction; Nutritional status; Outcome; Parathyroid gland; Patient Care; Patient Outcomes Assessments; Patients; Peripheral; Phosphorus; Population; Positioning Attribute; Potassium; Prevalence; Preventive; Proteins; Provider; Quality of Care; Questionnaires; Recurrence; Renal dialysis; Reporting; Research; Risk; Risk Factors; Serum Albumin; Serum Calcium Level; Shapes; Sleep Apnea Syndromes; Sodium; Stroke; System; Testing; Thromboembolism; Time; Treatment Factor; Urea; Urologic Diseases; Variant; Work; base; clinically relevant; cost; experience; health care service utilization; health related quality of life; high risk; improved; indium arsenide; innovation; instrument; interest; longitudinal database; low socioeconomic status; male; modifiable risk; mortality; novel; older patient; patient population; physical conditioning; point of care; prevent; public health relevance; treatment duration; trend

DESCRIPTION (provided by applicant): More than 575,000 Americans have end-stage renal disease, and more than 350,000 receive life-saving dialysis treatment. Previous research has demonstrated that patients undergoing hemodialysis, especially those who are older, are at particular risk to have atrial fibrillation. Atrial fibrillation is associated with poor outcomes including high mortality (40% per year). Little is known about fixed and potentially modifiable ris factors for atrial fibrillation in older patients receiving hemodialysis; there is also only scant evidence about these patients' outcomes after their first diagnosis with atrial fibrillation. From already collected Medicare insurance claims and medical records of a large dialysis provider, we propose to assemble a unique dataset that will provide unprecedented detail about these patients health and the health care they receive. In addition, we will have historical Medicare claims predating these patients' time of dialysis initiation by at least 2 years. Using this unique database, we will be in the unusual situation to be able to exclude patients who had atrial fibrillation before they started dialysis, and therefore be able to study incident atrial fibrillaton. We are proposing to identify potentially modifiable risk factors for incident atrial fibrillation, ith particular focus on laboratory measurements, vital signs, dialysis treatment- related factors, and dialysis facility practices. We will also launch a comprehensive assessment of the outcomes of patients once they are first diagnosed with atrial fibrillation, in comparison to similar patients who have not developed this arrhythmia. Outcomes of interest will cover all relevant domains: all-cause and cause-specific mortality; morbidity with focus on thromboembolic and hemorrhagic outcomes; patient-reported health-related quality of life outcomes; and health care utilization and cost. These studies will fill gaping holes in the currently available evidence. The perhaps most innovative aim will focus on deriving a prediction algorithm for near-term risk of new atrial fibrillation using the high-dimensional and extremely granular data in our dataset and novel bioinformatic methods. We will then validate the algorithm in a completely different later time period in data from the same provider as well as in another dataset from a different dialysis provider. If our approach proves successful in identifying patients at the highest near-term risk of incident atrial fibrillation, we are then in the position to test intervention studies to reducethe risk of imminent atrial fibrillation and thus avoid longer term sequelae of this arrhythmia in thes vulnerable patients. Findings from the proposed work have the potential to impact and improve the care that patients with end-stage renal disease receive. Our results may improve the quality of care received and, thus, the outcomes of this vulnerable patient population. The aims and scope of work are in full congruence with the mission of the National Institutes of Diabetes and Digestive and Kidney Diseases, and more specifically the Division of Kidney, Urologic, and Hematologic Diseases, which will consider this application for funding.

描述（由申请人提供）：超过57.5万美国人患有终末期肾病，超过35万人接受挽救生命的透析治疗。先前的研究表明，接受血液透析的患者，特别是那些年龄较大的患者，患房颤的风险特别高。房颤与不良预后相关，包括高死亡率（每年40%）。对于接受血液透析的老年患者房颤的固定和潜在可改变的危险因素知之甚少；关于这些患者首次诊断为房颤后的结果也只有很少的证据。从