optima4heart: pharmacological intervention and transition of care in cardiovascular disease management

需求：每天有2200名美国人死于心血管疾病，9210万人患有心血管疾病 某种形式的心脑血管疾病或中风。未控制的高血压(HTN)、心力衰竭(HF)、冠状动脉 心血管疾病(CAD)和房颤(AFib)是心血管疾病“流行”的主要驱动因素。这个 美国心脏病学会(ACC)建议改善护理的两个关键方向：(1) 推动有效治疗决策的药理学干预措施，以及(2)护理标准化 提供者之间治疗协议的交叉通信的流程。 解决方案：作为对ACC指导(如上)的响应，Optima集成健康旨在建立一个 临床医生信任的软件工具(optima4心脏)，建议：(1)药物干预和 (2)需要改变以团队为基础的护理转移[初级保健提供者(PCP)ó心脏病专家] 管理心血管疾病患者的临床医生。Optima4心脏可通过患者量身定做的临床应用 电子健康中的仪表板用户界面显示增强了分析智能(AI) 录制(EHR)。Optima4core直接解决了目前取得进展的障碍。它的目标是：(1)解决 治疗管理准则的不断变化的复杂性；(1b)统一和协调隔离 患者数据集；(2a)提供临床组织整合的药理学方法 干预措施；(B)制定一项护理转移部门间议定书。Optima4心是多- Optima4BP的疾病扩展，这是一种为解决药物干预而开发的人工智能解决方案 临床医生对失控HTN患者的管理。Optima4心脏目标：减少 心力衰竭、中风、心肌梗塞(MI)的发病率]或死亡。 第一阶段的目标：通过建立两种疾病的CVD药理来扩展optima4BP的能力 干预和转移护理平台，将HF与现有的HTN解决方案集成在一起。 具体目标为：目的1.建立和验证药理干预措施。最优4BP人工智能 框架将被调整，以优先处理实时的药物干预变化 基于患者状态变化的HF和HTN之间的动态变化。目标2.开发和验证高频传输 关爱的人。护理转移将确定患者是否稳定/不稳定，从而导致 关于护理分配的建议(适当时可转送护理)。目标1和目标2的验证将是 使用理论上的患者测试用例执行。最佳心脏药物干预的判定 由多学科临床团队进行的护理转移将确定其临床有效性。 未来工作：第二阶段将建立4种疾病的心血管疾病药物干预和转移护理 平台，扩展HTN+HF以包括CAD和AFIB。其结果是：一个灵活的护理管理平台 这可以适应影响心血管疾病“流行病”的主要驱动因素中的一个或任何组合。

Need: 2,200 Americans die of cardiovascular disease (CVD) each day, while 92.1 million live with some form of CVD or stroke. Uncontrolled hypertension (HTN), heart failure (HF), coronary artery disease (CAD), and atrial fibrillation (AFib) represent the primary drivers of the CVD “epidemic”. The American College of Cardiology (ACC) recommends two critical directions for improving care: (1) Pharmacological Interventions that drive effective treatment decisions, and (2) Standardization of Care Flows for cross-communication of treatment protocols amongst providers. Solution: In response to the ACC guidance (above), Optima Integrated Health aims to build a clinician-trusted software tool (optima4heart) that recommends: (1) a pharmacological intervention and (2) needed changes in team-based transfer of care [primary care provider (PCP) ó Cardiologist] for clinicians managing patients with CVD. optima4heart is clinically applicable through a patient-tailored analytic intelligence (AI) augmented by a dashboard user-interface display in the electronic health record (EHR). optima4heart directly addresses the current barriers to progress. It aims to: (1a) address the evolving complexity of the treatment management guidelines; (1b) unify and harmonize segregated patient datasets; (2a) provide a clinical organization-integrated approach to pharmacological interventions; (2b) establish an inter-division protocol for transfer of care. optima4heart is the multi- disease expansion of optima4BP, an AI solution developed to address pharmacological intervention management for clinicians treating patients with uncontrolled HTN. optima4heart Aim: Reduce the incidence of HF, stroke, myocardial infarction (MI)] or death. Goal of Phase I: Expand the capabilities of optima4BP by building a 2-disease CVD pharmacological intervention and transfer of care platform that integrates HF with the existing HTN solution. The Specific Aims are: Aim 1. Develop and Validate the Pharmacological Intervention. optima4BP AI framework will be adapted to prioritize pharmacological intervention changes that tackle the real-time dynamic between HF and HTN based on changing patient status. Aim 2. Develop and Validate HF Transfer of Care. The Transfer of Care will establish whether the patient is stable/unstable leading to a recommendation in assignment of care (transfer of care, when appropriate). Aim 1 & Aim 2 Validation will be performed using theoretical patient test cases. Adjudication of optima4heart pharmacological intervention and transfer of care by a multi-disciplinary clinical team will establish its clinical validity. Future Work: Phase II will establish a 4-disease CVD pharmacological intervention and transfer of care platform, expanding HTN + HF to include CAD and AFib. The result: a flexible care management platform that can adapt to one or any combination of the primary drivers impacting the CVD “epidemic”.