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Impact of Coronary Revascularization on Longitudinal Cognitive Change in the Elderly

冠状动脉血运重建对老年人纵向认知变化的影响

基本信息

批准号：
9751143
负责人：
Elizabeth Louisa Whitlock
金额：
$ 12.04万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9751143
关键词：
Acute Address Anecdotes Anesthesia procedures Anesthetics Attention Award Benefits and Risks Cardiac Surgery procedures Characteristics Clinical Cognition Cognitive Complement Consensus Coronary Coronary Arteriosclerosis Coronary Artery Bypass Counseling Data Dependence Development Elderly Event Funding Geriatrics Goals Head Health Health Promotion Health Status Health and Retirement Study Heart Heart Diseases Heterogeneity Impaired cognition Individual Inferior Intervention Interview K-Series Research Career Programs Lead Left Light Link Literature Measures Medical Medicare claim Medication Management Memory Mission Modeling National Institute on Aging Neurocognitive Occupational activity of managing finances Operative Surgical Procedures Outcome Patients Perioperative Perioperative Care Personal Satisfaction Physical Function Population Postoperative Period Procedures Publishing Pump Quality of life Reporting Research Research Personnel Respondent Risk Risk Management United States Work chronic pain clinically relevant cognitive ability cognitive benefits cognitive change cognitive function cognitive testing cohort coronary lesion high risk improved instrumental activity of daily living longitudinal dataset mortality novel older patient patient oriented patient subsets payment percutaneous coronary intervention post-operative cognitive dysfunction premature safety net social stroke risk surgery outcome

项目摘要

Project Summary/Abstract: Elders undergoing cardiac surgery are at particular risk of postoperative cognitive dysfunction (POCD), an acute decline in cognition persisting days, weeks, or months following surgery. Nonetheless, thousands of elders undergo coronary artery bypass grafting (CABG) each year in the United States in hopes of improving their health and function. Percutaneous coronary intervention (PCI) offers coronary revascularization that avoids major surgery and anesthetic exposure, which may be an attractive alternative to CABG for elderly patients concerned about durable cognitive decline following CABG despite inferior revascularization outcomes for certain coronary lesions. It is not known whether long-term cognition, on the timescale of anticipated clinical benefit of CABG, is impacted differently by CABG versus PCI, and whether cognitive change is truly new or a continuation of preoperative cognitive trajectory. We propose an analysis of biennial cognitive testing in the Health and Retirement Study (HRS) linked with Medicare claims data to investigate population-level cognitive trajectories spanning up to 20 years in elderly patients undergoing CABG or PCI. Using linear mixed- effects models, we will model raw and adjusted pre- and post-revascularization cognitive trajectories for elders undergoing CABG and PCI to evaluate whether long-term population-level pre- and post-procedural cognitive trajectory for patients undergoing CABG differs from that for patients undergoing PCI. Furthermore, under the hypothesis that there is heterogeneity among post-procedure cognitive trajectories beyond that predicted by pre-procedure trajectory, we will identify subpopulations of patients united by clinical characteristics who are at elevated risk of POCD. Finally, to complement results derived from objective cognitive testing, we will also study the impact of CABG versus PCI on patient-reported (subjective) cognitive function and ability of the respondent to complete cognitively-intensive instrumental activities of daily living, like medication and financial management. This study will shed new light on the clinical relevance of POCD after coronary revascularization, providing data from a novel and patient-relevant perspective which will help clinicians reconcile the potential risks of cognitive change with the medical necessity of these interventions in elders at high risk for catastrophic coronary occlusive events.

项目概要/摘要：接受心脏手术的老年人术后认知功能障碍（POCD）的风险特别高，术后持续数天、数周或数月的认知能力急性下降。尽管如此，在美国，每年都有老年人接受冠状动脉旁路移植术（CABG），健康和功能。经皮冠状动脉介入治疗（PCI）提供冠状动脉血运重建，避免了大手术和麻醉暴露，这可能是老年人CABG的一个有吸引力的替代方案尽管血运重建结局较差，但患者仍担心CABG后认知功能持续下降治疗某些冠状动脉病变目前尚不清楚，在预期的时间尺度上， CABG与PCI对CABG临床获益的影响不同，以及认知变化是否真的新的或术前认知轨迹的延续。我们提出了一个两年一次的认知测试分析在健康和退休研究（HRS）中，与医疗保险索赔数据相关联，以调查人口水平接受CABG或PCI的老年患者的认知轨迹长达20年。使用线性混合- 影响模型，我们将模拟原始和调整前和后的老年人血运重建认知轨迹接受CABG和PCI，以评估长期人群水平的术前和术后认知功能接受CABG的患者的轨迹不同于接受PCI的患者。此外，根据假设术后认知轨迹之间存在异质性，超出了术前轨迹，我们将确定符合以下临床特征的患者亚群： POCD的风险增加。最后，为了补充客观认知测试的结果，我们还将研究CABG与PCI对患者报告的（主观）认知功能和回答完成认知密集型工具性日常生活活动，如药物和财务管理这项研究将为冠状动脉造影后POCD的临床相关性提供新的线索。血运重建，从一个新的和患者相关的角度提供数据，这将有助于临床医生协调认知变化的潜在风险与老年人这些干预措施的医疗必要性，灾难性冠状动脉闭塞事件的高风险。