Outcomes and perspectives on treatment for critical limb ischemia in patients with end-stage renal disease

终末期肾病患者严重肢体缺血治疗的结果和前景

• 批准号: 10673924
• 负责人: Samir Kaushik Shah
• 金额: $ 14.4万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673924
• 关键词: Affect; Aftercare; American; Amputation; Biology; Blood Vessels; Bypass; Cardiology; Cardiovascular system; Caring; Catheters; Clinical Research; Complement 3; Conflict (Psychology); Data; Decision Aid; Decision Making; Development; Diagnosis; Dialysis procedure; Disease; End stage renal failure; Environment; Fee-for-Service Plans; Florida; Foundations; Gangrene; Geography; Goals; Grant; Guidelines; Health Personnel; Health Services Research; Hemodialysis; Hospital Referrals; Incidence; Intervention; Kidney Failure; Knowledge; Leadership; Learning; Length of Stay; Life; Limb structure; Literature; Managed Care; Medicare; Medicare claim; Medicine; Mentors; Mentorship; Methods; Morbidity - disease rate; Nephrology; Operative Surgical Procedures; Outcome; Outcomes Research; Pain; Pain management; Patient-Centered Care; Patient-Focused Outcomes; Patients; Peripheral arterial disease; Persons; Physicians; Population; Population Heterogeneity; Positioning Attribute; Procedures; Process; Provider; Recommendation; Research; Research Personnel; Research Priority; Resources; Rest; Risk Factors; Sample Size; Selection for Treatments; Societies; Stents; Symptoms; Techniques; Training; Treatment Factor; Treatment outcome; Universities; Vascular Diseases; Writing; accountable care organization; beneficiary; care outcomes; career; career development; clinical care; college; comorbidity; critical limb Ischemia; experience; follow-up; improved; large datasets; limb loss; mortality; multidisciplinary; non-healing wounds; preference; programs; risk sharing; satisfaction; shared decision making; skill acquisition; skills; treatment as usual; treatment choice; wound care

Project Summary/Abstract Amputation and mortality rates are extraordinarily high for patients living with both advanced peripheral arterial disease, or critical limb ischemia (CLI), and end-stage renal disease (ESRD). Treatment choices for patients with CLI include catheter-based procedures (e.g. vascular stenting), surgery (e.g. bypass), primary amputation, or symptom control alone (e.g. pain management and wound care). Overall, CLI has dismal outcomes with a 25% mortality and a 30% major amputation rate at one year from diagnosis. Limited data suggest even worse outcomes for patients with ESRD – for example, approximately 50% mortality at 18 months. The existing literature on outcomes is limited by small sample sizes, short follow-up, and a focus on only two of the treatment options, catheter-based interventions and surgery. Patients with ESRD and CLI are often faced with difficult treatment decisions that are complicated by a lack of 1) robust real-world evidence on outcomes and 2) clinical care guidelines. Shared decision-making often relies on these types of information. ESRD is a life-limiting disease and treatment of CLI is resource-intensive. Nevertheless, there are no existing cardiovascular or nephrology society guidelines regarding CLI treatment in patients with ESRD. Knowledge of outcomes of CLI treatment in patients with ESRD, factors affecting CLI treatment selection, and guidelines to direct care would unequivocally improve care by helping to align patient values and preferences with treatment decisions. Owing to these gaps in knowledge, I propose a mixed methods approach using the national Medicare data 2017-2019 to understand 1) factors affecting treatment selection, and 2) traditional and patient-centered outcomes after treatment of CLI in patients with ESRD, complemented by 3) a Delphi panel of expert health care providers and patients to help inform the establishment of care guidelines and identification of research priorities. In addition to helping develop critical data on patients with ESRD and CLI, this proposal will be an essential step in my development as an independent investigator. My long-term career goals are to develop a research program focusing on outcomes of treatment and decision-making surrounding peripheral arterial disease. I hope to advance the field of vascular surgery health services research to improve patient outcomes and aid physicians and patients in aligning decision-making with patient goals and values. This proposal will immediately contribute to my short-term career objectives: increasing expertise with use of Medicare fee-for- service claims data, understanding the practice of nephrology as it applies to ESRD and comorbid conditions such as CLI, learning relevant advanced quantitative and qualitative techniques, and improving grant writing, leadership, and other career development skills. This proposal will take place in the resource-rich environment of the University of Florida College of Medicine under the guidance of an expert mentoring team.

项目摘要/摘要 生活在两种晚期外周疾病患者的截肢率和死亡率都非常高。 动脉疾病或严重肢体缺血(CLI)和终末期肾病(ESRD)。治疗选择 CLI患者包括基于导管的手术(例如血管支架置入术)、手术(例如搭桥)、原发 截肢或仅控制症状(例如疼痛管理和伤口护理)。总体而言，CLI令人沮丧 结果在确诊后一年死亡率为25%，截肢率为30%。有限的数据 对终末期肾病的患者来说，结果甚至更糟--例如，18岁时死亡率约为50% 月份。现有关于结果的文献受到样本量小、随访时间短以及对以下方面的关注的限制 只有两种治疗选择，基于导管的干预和手术。患有ESRD和CLI的患者为 经常面临困难的治疗决定，这些决定因缺乏可靠的现实世界证据而变得复杂 结果和2)临床护理指南。共享决策通常依赖于这些类型的信息。 ESRD是一种限制生命的疾病，CLI的治疗是资源密集型的。尽管如此，没有 关于终末期肾病患者CLI治疗的现有心血管或肾脏学会指南。 终末期肾病患者CLI治疗结果的知识，影响CLI治疗选择的因素，以及 直接护理的指导方针将通过帮助使患者的价值观和偏好相一致来明确地改善护理 与治疗决定有关。由于这些知识上的差距，我提出了一种混合方法方法，使用 2017-2019年全国医疗保险数据，以了解1)影响治疗选择的因素，以及2)传统和 终末期肾病患者CLI治疗后以患者为中心的结果，辅以3)Delphi专家小组 专业的医疗保健提供者和患者，帮助建立护理指南和识别 研究的优先顺序。 除了帮助开发ESRD和CLI患者的关键数据外，这项提案还将是 作为一名独立调查员，这是我发展的关键一步。我的长期职业目标是发展一种 专注于周围动脉治疗和决策结果的研究计划 疾病。我希望推进血管外科健康服务领域的研究，以改善患者的预后 并帮助医生和患者使决策与患者的目标和价值观保持一致。这项提议将 立即为我的短期职业目标做出贡献：通过使用联邦医疗保险收费来增加专业知识- 服务索赔数据，了解适用于终末期肾病和合并疾病的肾脏病的实践 例如CLI，学习相关的先进定量和定性技术，并改进赠款的撰写， 领导力和其他职业发展技能。这项提议将在资源丰富的环境中进行 在一个专家指导小组的指导下，佛罗里达大学医学院。

项目成果

National Institutes of Health funding among vascular surgeons is rare.

美国国立卫生研究院对血管外科医生的资助很少。

• DOI: 10.1016/j.jvs.2023.05.052
• 发表时间: 2023
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Mirzaie,AminA;Cooper,MicholA;Weaver,MLibby;Jacobs,ChristopherR;Cox,MorganL;Berceli,ScottA;Scali,SalvatoreT;Back,MartinR;Huber,ThomasS;Upchurch,GilbertR;Shah,SamirK
• 通讯作者: Shah,SamirK