Re-thinking the Role of Stress Imaging for Symptomatic Older Adults with Stable Coronary Artery Disease

重新思考压力成像对患有稳定型冠状动脉疾病的有症状老年人的作用

• 批准号: 10727942
• 负责人: Krishna Kaushik Patel
• 金额: $ 16.9万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10727942
• 关键词: Acceleration; Affect; Age; Age Years; Aging; Area; Attitude; Award; Cardiac; Cardiovascular system; Caregivers; Caring; Characteristics; Chest Pain; Chronology; Clinical; Cognition; Coronary Arteriosclerosis; Data; Decision Aid; Decision Making; Development; Diagnosis; Diagnostic; Dyspnea; Elderly; Evaluation; Focus Groups; Foundations; Funding; Future; Geriatric Assessment; Geriatrics; Goals; Grant; Group Interviews; Health system; Image; Impaired cognition; Impairment; Interview; Ischemia; Medical; Mentors; Mentorship; Myocardial Ischemia; Nuclear; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Population; Probability; Qualitative Research; Quality of life; Registries; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Stress; Stress Tests; Structure; Symptoms; Test Result; Testing; Thinking; Training; Vascularization; Work; age related; cardiovascular imaging; care costs; empowerment; evidence base; frailty; functional status; improved; improved outcome; multidisciplinary; multiple chronic conditions; nuclear imaging; older patient; personalized decision; personalized risk prediction; preference; risk prediction model; shared decision making; symptom treatment; treatment choice; treatment planning; treatment strategy

PROJECT SUMMARY/ABSTRACT More than a quarter of all adults older than 75 years have symptomatic stable ischemic heart disease. Stress nuclear imaging is the one of the most common tests performed for diagnosis and management of coronary artery disease in these older adults. Older adults are more likely to have co-existing impairments in function, cognition and multimorbidity, which may limit their benefit from imaging tests and post-test treatment, alike. Although stress testing is often used to evaluate symptoms, clinicians are less likely to refer older adults for revascularization or to optimize their medical therapy, even if stress test results are severely abnormal. In turn, this can result in overuse of testing, increased complications and cost of care without improving patient outcomes. To help older patients presenting with suspected ischemic symptoms make a well-informed decision, clinicians should contextualize the benefits of imaging and treatment strategies post imaging in context of elicited goals of care, clinical impairments. It is critical to understand presentation, cardiac risk factors and potential age-related how to improve shared decision making among older adults and identify areas of imaging test overuse or underuse among older adults with symptomatic stable ischemic heart disease. In this project, I use a multi-stakeholder approach to understand post-stress test decision making from patient, caregiver and physician perspectives and study its association with outcomes among symptomatic older adults with suspected or known CAD. My research aims are to (a) understand older patient and caregiver attitudes about post-imaging treatment choice in context of their preferred outcomes and age-related impairments through focus group interviews and (b1) examine the association between cardiovascular and geriatric risk factors on post-imaging treatment choice (i.e., invasive referral vs. medical optimization); and (b2) compare the association of treatment received post-imaging and patients' symptoms, function and quality of life among symptomatic older adults  75 years undergoing clinically indicated stress nuclear imaging within our health system. This study will help inform my future work aimed at developing and testing personalized decision aids to guide choice of testing and treatment for symptomatic older adults with CAD. This GEMSSTAR award will also provide me with the support, mentorship and training required to become a leader in field of cardiovascular imaging and shared decision-making for older adults with stable ischemic heart disease.

项目总结/摘要 超过四分之一的75岁以上的成年人患有症状稳定的缺血性心脏病。应力 核成像是用于诊断和管理冠状动脉疾病的最常见的检查之一。 老年人的动脉疾病老年人更有可能同时存在功能障碍， 认知和多发病，这可能会限制他们从成像测试和测试后治疗中获益。 虽然压力测试通常用于评估症状，但临床医生不太可能将老年人转诊为 即使压力测试结果严重异常，患者也可以接受血运重建或优化药物治疗。反过来， 这可能导致过度使用测试，增加并发症和护理成本，而不会改善患者的健康状况。 结果。为了帮助出现疑似缺血症状的老年患者， 因此，临床医生应该将成像和成像后治疗策略的益处置于背景中， 引出的护理目标的背景，临床 损伤我们需要了解 临床表现、心脏危险因素和潜在年龄相关 如何改善老年人之间的共同决策， 有症状的稳定性缺血心脏老年人中过度使用或使用不足的成像测试领域 疾病 在这个项目中，我使用多利益相关者的方法来了解患者的压力测试后决策， 护理人员和医生的观点，并研究其与有症状的老年人的结果之间的关联 疑似或已知CAD。我的研究目的是（a）了解老年病人和照顾者的态度 关于在其首选结局和年龄相关损伤背景下的成像后治疗选择 通过焦点小组访谈和（b1）检查心血管和老年风险之间的关联 关于成像后治疗选择的因素（即，侵入性转诊与医疗优化）;和（b2）比较 影像学检查后接受的治疗与患者的症状、功能和生活质量之间的相关性 在我们的健康范围内，有症状的75岁以上的老年人接受临床指示的应力核成像 系统这项研究将有助于通知我未来的工作，旨在开发和测试个性化的决策辅助工具 指导有症状的老年CAD患者的检测和治疗选择。本次GEMSSTAR奖将 我还为我提供了成为该领域领导者所需的支持、指导和培训， 心血管成像和共享决策的老年人与稳定的缺血性心脏病。