Decision Making for Cardiovascular Therapy in Adults with Mild Cognitive Impairment

轻度认知障碍成人心血管治疗的决策

• 批准号: 9346592
• 负责人: Deborah Levine
• 金额: $ 74.04万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9346592
• 关键词: Activities of Daily Living; Acute; Acute myocardial infarction; Address; Adult; Affect; Aftercare; American; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Cognitive; Complex; Data; Data Analyses; Decision Making; Dementia; Development; Elderly; Event; Face; Goals; Guidelines; Hand; Health; Health Services Research; Health and Retirement Study; Heart; Human; Impaired cognition; Intervention; Interview; Ischemic Stroke; Knowledge; Lead; Life Expectancy; Link; Longitudinal cohort; Measures; Medicare; Methods; Michigan; Mission; Modeling; Morbidity - disease rate; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Physicians; Population; Public Health; Quality of life; Recommendation; Rehabilitation therapy; Research; Research Proposals; Risk; Secondary Prevention; Secondary to; Stroke; Structure; Surveys; Testing; Time; Translating; Treatment outcome; United States National Institutes of Health; Universities; Work; advanced dementia; cardiovascular disorder risk; clinical decision-making; cohort; design; disability; disorder risk; effective therapy; experience; improved; innovation; mild cognitive impairment; mortality; novel strategies; older patient; population based; preference; prevent; public health relevance; standard care; stroke treatment; therapy design

 DESCRIPTION (provided by applicant): There is a fundamental gap in understanding how mild cognitive impairment (MCI) influences treatment and decision making for serious illnesses, like cardiovascular disease (CVD), in older patients. Poor understanding of clinical decision making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, rehabilitation, and secondary prevention. Our central hypothesis is that older adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and decision making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.

 描述（由申请人提供）：对于老年患者的轻度认知障碍（MCI）如何影响心血管疾病（CVD）等严重疾病的治疗和决策的理解存在根本性差距。对临床决策的了解不足是设计干预措施以提高老年 MCI 患者 CVD 护理质量和结果的关键障碍。这项研究的长期目标是开发、测试和传播干预措施，旨在提高 CVD 护理的质量和结果，并减少患有 MCI 的美国老年人与 CVD 相关的残疾。此应用程序的目的是确定 MCI 患者在两种最常见的 CVD 事件（急性心肌梗死 (AMI) 和急性缺血性中风）中接受不合格护理的程度，从而增加生活质量良好的人群的死亡率和发病率，并确定 MCI 如何影响患者偏好和医生的治疗建议。 AMI 和急性缺血性中风是严重急性疾病的绝佳模型，具有多种有效的急性治疗、康复和二级预防疗法。我们的中心假设是，患有 MCI 的老年人的 CVD 治疗不足，因为患者和医生高估了他们患痴呆症的风险，而低估了他们患 CVD 的风险。该假设是根据申请人试点研究的初步数据制定的。拟议研究的基本原理是，了解患者偏好和医生建议如何导致 MCI 患者 CVD 治疗使用不足，有可能转化为旨在提高护理质量和结果的有针对性的干预措施，从而产生治疗 MCI 成人 CVD 和其他严重急性疾病的创新方法。在强有力的初步数据的指导下，这一假设将通过追求两个具体目标进行检验：1）比较 MCI 患者和认知正常患者的 AMI 和卒中治疗，并探索与治疗差异相关的临床结果差异； 2) 确定 MCI 对患者和代理人偏好以及医生对 AMI 和中风治疗建议的影响。根据第一个目标，卫生服务研究方法（在申请人手中已被证明是可行的）将用于量化老年 MCI 患者的 AMI 和急性缺血性中风治疗差异的程度和结果。在第二个目标下，将采用多中心、混合方法和全国医师调查（在申请人手中也被证明是可行的）来确定 MCI 对患者偏好和医师对 AMI 和中风治疗建议的影响。这项研究提案具有创新性，因为它代表了一种新的、截然不同的方法，通过确定 MCI 患者未充分利用有效 CVD 治疗的程度和原因，来解决增强老年人健康这一重要的公共卫生问题。拟议的研究意义重大，因为它有望纵向推进和扩大对 MCI 如何影响老年患者 AMI 和缺血性中风的治疗和决策的理解。最终，这些知识有可能为有针对性的干预措施的制定提供信息，从而有助于提高 CVD 护理的质量和结果，并减少美国老年人与 CVD 相关的残疾。