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.

项目摘要/摘要 在75岁以上的所有成年人中，有四分之一以上患有症状稳定的缺血性心脏病。压力 核成像是用于诊断和管理冠状动脉的最常见测试之一 这些老年人的动脉疾病。老年人更有可能在功能中共存障碍， 认知和多种疾病，这可能会限制其成像测试和测试后治疗的益处。 尽管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介 即使压力测试结果严重异常，血运重建或优化其医疗疗法。反过来， 这可能导致测试过度使用，增加的并发症和护理成本，而无需改善患者 结果。为了帮助老年患者出现可疑缺血症状，使得良好 决定，临床医生应在成像后的成像和治疗策略的好处背景 引起护理目标，临床目标的背景 障碍。理解至关重要 表现，心脏危险因素和潜在与年龄有关 如何改善老年人共享决策并确定 成像测试的领域过度使用或不足的老年人有症状稳定的缺血性心脏 疾病。 在这个项目中，我使用多方利益相关者的方法来了解患者的压力测试决策， 护理人员和物理观点，研究其与有症状的老年人的结局的联系 带有可疑或已知的CAD。我的研究目的是（a）了解老年患者和照料者参加 关于在他们的首选结果和与年龄相关的障碍的背景下，有关后成像的治疗选择 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 现象后治疗选择的因素（即侵入性推荐与医学优化）； （b2）比较 治疗的关联接受了模仿后以及患者的症状，功能和生活质量 有症状的老年人75岁，经历了我们健康中的压力核成像 系统。这项研究将有助于告知我未来的工作，旨在制定和测试个性化决策辅助工具 指导对有症状的老年人CAD的测试和治疗选择。这个Gemsstar奖将 还为我提供成为领域领导者所需的支持，指导和培训 对于患有稳定的缺血性心脏病的老年人的心血管成像和共享决策。