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

描述（由申请人提供）：超过575，000名美国人患有终末期肾病，超过350，000人接受挽救生命的透析治疗。以前的研究表明，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。房颤与不良结局相关，包括高死亡率（每年40%）。在接受血液透析的老年患者中，关于房颤的固定和潜在可改变的风险因素知之甚少;关于这些患者首次诊断为房颤后的结局也缺乏证据。 从 我们已经收集了一家大型透析提供商的医疗保险索赔和医疗记录，我们建议收集一个独特的数据集，该数据集将提供有关这些患者健康状况和他们接受的医疗保健的前所未有的详细信息。此外，我们将有这些患者透析开始前至少2年的历史医疗保险索赔。利用这种独特的 数据库中，我们将在不寻常的情况下能够排除在开始透析前患有房颤的患者，因此能够研究事件心房颤动。 我们建议识别房颤事件的潜在可改变风险因素，特别关注实验室测量、生命体征、透析治疗相关因素和透析机构实践。我们还将对首次诊断为房颤的患者的结局进行全面评估，并与未发生这种心律失常的类似患者进行比较。关注的结局将涵盖所有相关领域：全因和病因特异性死亡率;关注血栓栓塞和出血结局的发病率;患者报告的健康相关生活质量结局;以及医疗保健利用和成本。这些研究将填补现有证据中的漏洞。也许最具创新性的目标将集中在使用我们数据集中的高维和极细粒度数据以及新的生物信息学方法来推导新的房颤近期风险的预测算法。然后，我们将在来自同一提供者的数据以及来自不同透析提供者的另一个数据集中，在完全不同的后期时间段内验证算法。如果我们的方法被证明成功识别出近期发生房颤风险最高的患者，那么我们就可以对干预研究进行测试，以降低即将发生房颤的风险，从而避免这些脆弱患者发生心律失常的长期后遗症。 这项研究的结果有可能影响和改善终末期肾病患者接受的护理。我们的研究结果可能会提高所接受的护理质量，从而改善这一弱势患者群体的结局。工作的目标和范围与国家糖尿病、消化和肾脏疾病研究所的使命完全一致，更具体地说，与肾脏、泌尿系统和血液系统疾病研究所完全一致，该研究所将考虑这项资助申请。

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.