Palliative Care for High-Risk TAVR Patients: The Impact of Multimorbidity

高危 TAVR 患者的姑息治疗：多发病的影响

• 批准号: 9762764
• 负责人: Benjamin Seth Wessler
• 金额: $ 19.28万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762764
• 关键词: Address; Affect; Aftercare; Age; Aging; Aortic Valve Stenosis; Award; Cardiomyopathies; Cardiovascular Diseases; Cardiovascular Models; Cardiovascular system; Caregivers; Caring; Catheters; Cessation of life; Cities; Clinical; Clinical Trials; Comorbidity; Complex; Consultations; Data; Disease; Elderly; Enrollment; Feasibility Studies; Focus Groups; Funding; Goals; Heart Valve Diseases; Internal Medicine; Intervention; Kansas; Knowledge; Measures; Medical center; Medicare/Medicaid; Mentors; Methods; Morbidity - disease rate; National Institute on Aging; Needs Assessment; Outcome; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Pilot Projects; Population; Procedures; Quality of life; Registries; Research; Research Methodology; Research Personnel; Resources; Risk; Risk Assessment; Role; Testing; Therapeutic; Training; United States; Work; aortic valve replacement; arm; base; cardiovascular risk factor; career; clinical care; clinical predictors; cohort; end of life; frailty; high risk; implementation science; improved; improved outcome; insight; mortality; multiple chronic conditions; new technology; novel; pilot trial; predictive modeling; primary outcome; prospective; standard care; success; treatment strategy; valve replacement

Project Summary Moderate to severe valvular heart disease is a major cause of morbidity and mortality for the aging U.S. population and transcatheter aortic valve replacement (TAVR) has revolutionized care for older adults with symptomatic aortic stenosis and elevated pre-procedural risk. Not all patients benefit from treatment and one third of TAVR patients remain severely symptomatic or die 1 year after treatment. Comorbid conditions are likely the major determinants of benefit following TAVR since half of all deaths following treatment are due to non-cardiac causes. No studies have explored the impact of multiple chronic conditions (MCC) on patient- centered outcomes following TAVR, nor studied the benefits of palliative care (PC) for high-risk patients. This proposal addresses knowledge gaps related to the significance of MCC and the use of early PC for high-risk cardiovascular patients. Aim 1 of this research will determine the impact of MCC on short-term quality of life (QOL), mortality, and PC use for high-risk TAVR patients enrolled in the Transcatheter Valve Therapy Registry. Aim 2 will use focus groups to characterize the care needs of high-risk older adults treated with TAVR. Aim 3 is a feasibility study of adding early PC to standard care for high-risk TAVR patients with MCC. The pilot trial will determine if PC can be introduced early after TAVR for patients likely to have PC needs. The primary outcome is short-term QOL as measured by Kansas City Cardiomyopathy Questionaire. Interventions for older adults with advanced VHD are rapidly increasing both in scope and availability. Completion of the aims will determine whether MCC for high-risk TAVR patients negatively impacts patient-centered outcomes and whether MCC can be used to identify patients who are likely to benefit from PC. Thus, this research aligns with the priorities of the National Institute on Aging to improve clinical care for patients with MCC. This mentored award will support essential training in PC research methods, registry analytics, implementation science and clinical trial management.

项目摘要 中度至重度瓣膜心脏病是美国衰老的发病率和死亡率的主要原因 人口和经导管主动脉瓣更换（TAVR）已彻底改变了老年人的护理 有症状的主动脉狭窄和术前风险升高。并非所有患者都受益于治疗，一个 三分之一的TAVR患者在治疗后1年仍然严重症状或死亡。合并条件是 TAVR之后的利益的主要决定因素可能是由于治疗后所有死亡的一半是由于 非心脏原因。没有研究探讨了多种慢性病（MCC）对患者的影响 塔夫（Tavr）之后的集中结果也没有研究姑息治疗（PC）对高危患者的好处。这 提案解决了与MCC重要性以及早期PC用于高风险的知识差距 心血管患者。这项研究的目标1将决定MCC对短期生活质量的影响 （QOL），死亡率和PC用于纳入经导管瓣治疗的高危TAVR患者 注册表。 AIM 2将使用焦点小组来表征接受治疗的高风险老年人的护理需求 塔夫。 AIM 3是一项可行性研究，将早期PC添加到MCC高危TAVR患者的标准护理中。 试点试验将确定在TAVR后针对可能需要PC需求的患者的TAVR后是否可以提早引入PC。这 主要结果是堪萨斯城心肌病问题的短期QOL。干预措施 对于患有晚期VHD的老年人，范围和可用性都在迅速增加。完成 AIMS将确定高风险TAVR患者的MCC是否对以患者为中心的结果负面影响 以及MCC是否可以用于识别可能从PC中受益的患者。因此，这项研究保持一致 随着国家衰老研究所的优先事项，可以改善MCC患者的临床护理。这 指导奖将支持PC研究方法，注册表分析，实施中的基本培训 科学与临床试验管理。