Optimizing Revascularization of Coronary Artery Disease in Chronic Kidney Disease

优化慢性肾脏病冠状动脉疾病的血运重建

基本信息

批准号：
8787487
负责人：
David M Charytan
金额：
$ 41.43万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-01-01 至 2017-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8787487
关键词：
Accounting Address Adverse event Affect Attenuated Cardiovascular Diseases Cardiovascular system Caring Cessation of life Chronic Chronic Kidney Failure Clinical Clinical Data Clinical Trials Clinical effectiveness Coronary Coronary Arteriosclerosis Coronary Artery Bypass Cost of Illness Cost utility Data Data Analyses Data Set Dependence Dialysis procedure End stage renal failure Equilibrium Exclusion Expenditure Facilities and Administrative Costs Fatal Outcome Fright Functional disorder General Population Growth Guidelines Health Health Care Costs Health Expenditures Health Policy Healthcare High Prevalence Incidence Individual Information Systems Injury Kidney Kidney Diseases Kidney Failure Knowledge Life Link Massachusetts Measures Medical Medicare Modality Modeling Myocardial Infarction Operative Surgical Procedures Outcome Patient Care Patient risk Patients Perioperative Physicians Population Postoperative Period Prevalence Procedures Public Health Quality of Care Quality of life Registries Renal function Resources Risk Risk Estimate Risk Factors Safety Sampling Stroke Time United States base cardiovascular disorder therapy cardiovascular risk factor care delivery clinical decision-making cohort comparative comparative effectiveness comparative efficacy cost cost effectiveness design disorder risk evidence base follow-up health related quality of life high risk improved mortality patient population percutaneous coronary intervention public health relevance standard of care

项目摘要

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects > 6% of the U.S. population and accounts for a high share of health care spending. Although patients with CKD have a risk of cardiovascular mortality significantly higher than the general population, they are nevertheless less likely to undergo coronary revascularization or receive standard medical therapies for cardiovascular disease (CVD). The low utilization of potentially life-saving therapies may be influenced by the unique pathophysiology of CVD in CKD, evidence suggesting low efficacy of standard therapies in advanced CKD, and the systematic exclusion of CKD patients from clinical trials that established the benefits of medical therapy (MTX), percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) in the general population. Concerns raised by these factors about extrapolating cardiovascular guidelines from the general population to the care of individuals with CKD are magnified by the threat of procedure-related kidney injury following PCI and CABG. Revascularization may accelerate progression of renal disease and, when permanent dialysis dependence results, can dramatically reduce quality of life despite relief of angina. Other complications, such as stroke, whose incidence may differ after MTX, PCI and CABG, are likely to have analogous impacts on the benefits of the individual treatment options. Despite the growth in the CKD population, the ubiquity of CVD in CKD, and concerns about the application of the general standard of care, specific evidence of the comparative efficacy of therapies in CKD remains sparse, with little information on comparative costs or overall quality of life. This absence of good data likely results in the inefficient use of these therapies, suboptimal clinical outcomes, and unnecessary burdens on health care resources. To better inform patients, physicians, and other stakeholders, better comparative effectiveness data and an analysis of associated health care expenditures are needed to identify strategies which maximize health gains and cost-efficiency. The proposed studies are critically needed to better inform clinical decision-making and public health discourse. We propose a unique analysis of Medicare data and a linkage of the Massachusetts state PCI and CABG registries with the United States Renal Data System. These data sets will enable analyses designed to address important questions and facilitate optimal use of, MTX, CABG and PCI in CKD. Associations between therapy and relevant outcomes such as death, end stage renal disease, stroke, myocardial infarction, and healthcare associated costs will be estimated. Leveraging these data, we will analyze quality-adjusted survival and incremental cost-effectiveness using decision and cost-utility analytics.

描述（由申请人提供）：慢性肾脏疾病（CKD）影响> 6％的美国人口，并占医疗保健支出的份额很高。尽管CKD患者患心血管死亡率的风险明显高于一般人群，但他们接受冠状动脉血运重建或接受心血管疾病（CVD）的标准医疗疗法的可能性较小。 CKD中CVD的独特病理生理学的潜在挽救生命疗法的使用率低可能会影响，这表明标准疗法在晚期CKD中的疗效较低，以及从临床试验中将CKD患者系统排除在临床试验中，这些试验确定了医疗疗法（MTX）（MTX）的益处（MTX），cablane coronare carenary comerare interary（PCI ARON）。这些因素引起的担忧是通过PCI和CABG后与手术相关的肾脏损伤的威胁来放大了将心血管指南从一般人群中外推到CKD患者的护理。血运重建可能会加速肾脏疾病的进展，并且当永久性透析依赖性结果时，尽管缓解了心绞痛，但仍可以大大降低生活质量。其他并发症（例如中风）在MTX，PCI和CABG之后可能有所不同，可能会对单个治疗方案的好处产生类似的影响。尽管CKD人群的增长，CKD中CVD的普遍存在以及对普通护理标准的担忧，但CKD中治疗疗法比较疗效的具体证据仍然很少，几乎没有有关比较成本或整体生活质量的信息。缺乏良好的数据可能导致这些疗法的使用效率低下，次优临床结果以及对医疗保健资源的不必要负担。为了更好地告知患者，医生和其他利益相关者，需要更好的比较有效性数据，并需要对相关的医疗保健支出进行分析，以确定最大程度地提高健康增长和成本效益的策略。迫切需要进行拟议的研究，以更好地为临床决策和公共卫生的话语提供信息。我们提出了对Medicare数据的独特分析，以及马萨诸塞州PCI和CABG注册机构与美国肾脏数据系统的联系。这些数据集将实现旨在解决重要问题的分析，并促进CKD中MTX，CABG和PCI的最佳使用。将估计治疗与相关结果之间的关联，例如死亡，末期肾脏疾病，中风，心肌梗塞和医疗保健相关费用。利用这些数据，我们将使用决策和成本效用分析分析质量调整后的生存和增量成本效益。