Treatment Endpoints in Acute Decompensated Heart Failure

急性失代偿性心力衰竭的治疗终点

• 批准号: 7679370
• 负责人: SEAN PATRICK COLLINS
• 金额: $ 16.09万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679370
• 关键词: Accident and Emergency department; Acute; Admission activity; Adverse event; Aftercare; Behavioral; Budgets; Caring; Clinical; Clinical Data; Clinical Investigator; Clinical Research; Cohort Studies; Complement; Complex; Consumption; Coronary; Coronary Arteriosclerosis; Coronary Artery Bypass; Data; Decision Making; Decision Modeling; Development; Diagnosis; Disease; Economic Burden; Emergency Situation; Enrollment; Environment; Event; Fellowship; Functional disorder; Future; Goals; Guidelines; Health; Health behavior; Healthcare; Healthcare Systems; Heart failure; Home environment; Hospital Mortality; Hospitalization; Hospitals; Hour; Incidence; Individual; Inpatients; Intervention; Interview; Knowledge; Laboratories; Length of Stay; Measures; Medical; Mentors; Methodology; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Natriuretic Peptides; Outcome; Outcomes Research; Parents; Patient Discharge; Patients; Physicians; Physiological; Process; Qualifying; Quality of Care; Research; Research Methodology; Research Personnel; Resources; Risk; Risk Behaviors; Risk Marker; Science; Stratification; Targeted Research; Testing; Therapeutic; Time; Uncertainty; Work; abstracting; base; clinical care; cohort; cost; cost effectiveness; evidence base; experience; high risk; improved; innovation; insight; mathematical model; mortality; patient population; practical application; programs; prospective; recidivism; social; success; treatment response

DESCRIPTION (provided by applicant): A fundamental question faced by physicians treating acute decompensated heart failure (ADHF) is 'When has treatment worked sufficiently for safe discharge, and who requires further treatment?' Patients with ADHF have a high incidence of morbidity and mortality. Current guidelines for emergency department (ED) and hospital disposition of patients with ADHF are based on limited empirical evidence. This creates clinical uncertainty regarding disposition, leads to prolonged hospitalizations, higher costs and increased resource consumption. Conducting a project to answer this question, in combination with carefully planned didactics and mentoring from distinguished researchers, will allow me to develop as an independent clinical investigator with a primary focus on decision making in patients with ADHF. The ED is the portal of entry for the majority of ADHF admissions and presents fertile ground for prospectively studying decision making. My specific aims are: 1) to further develop knowledge in clinical research, advanced modeling, and decision sciences to advance my development as an independent clinical investigator and 2) to develop a prediction rule from readily available clinical data that helps physicians identify ADHF patients for whom early discharge from the ED and hospital is safe after treatment is initiated. In recognition of the importance of the ED in ADHF care, the NHLBI is supporting our observational cohort study of 1800 ED patients to develop a prediction rule for initial risk-stratification (STRATIFY- 1R01HL088459). To complete my aim, I will collect additional data on a subset of 500 patients from STRATIFY whose baseline data is collected within 1 hour of ED therapy. In addition to the baseline data from STRATIFY, the current proposal will collect clinical and laboratory data 2-4 hours, 12-24 hours and 96 hours after treatment is begun. We will also interview patients to measure social and behavioral variables. We will use this additional data to develop a second prediction rule to assist physicians in identifying patients safe for early ED and hospital discharge after therapy is begun. This project is an ideal vehicle for practical application of didactic knowledge gained, offers an intensive clinical research experience, and promises to generate extensive preliminary data to fully expand a long-term research program. My clinical research, didactic program and advanced biostatistical and modeling coursework will be supervised by a highly qualified, multi-disciplinary team of talented individuals, Building from my completed Outcomes Research fellowship and previous research experience, this proposal will allow me to mature as a clinical investigator, develop a prediction rule for decision making in ADHF, and engender evidence- based research in a disease process with tremendous healthcare system implications. (End of Abstract)

描述（由申请人提供）：治疗急性失代偿性心力衰竭（ADHF）的医生面临的一个基本问题是“治疗何时足以安全出院，谁需要进一步治疗？” ADHF 患者的发病率和死亡率很高。目前急诊室 (ED) 和医院处理 ADHF 患者的指南基于有限的经验证据。这造成了处置方面的临床不确定性，导致住院时间延长、费用增加和资源消耗增加。开展一个项目来回答这个问题，结合精心策划的教学和杰出研究人员的指导，将使我成为一名独立的临床研究者，主要关注 ADHF 患者的决策。 ED 是大多数 ADHF 入学的入口，为前瞻性学习决策提供了肥沃的土壤。我的具体目标是：1) 进一步发展临床研究、高级建模和决策科学方面的知识，以促进我作为独立临床研究者的发展；2) 根据现成的临床数据制定预测规则，帮助医生识别 ADHF 患者，在治疗开始后，尽早从急诊室和医院出院是安全的。认识到 ED 在 ADHF 护理中的重要性，NHLBI 支持我们对 1800 名 ED 患者进行观察性队列研究，以制定初始风险分层的预测规则 (STRATIFY-1R01HL088459)。为了完成我的目标，我将从 STRATIFY 收集 500 名患者的额外数据，这些患者的基线数据是在 ED 治疗 1 小时内收集的。除了 STRATIFY 的基线数据外，当前提案还将收集治疗开始后 2-4 小时、12-24 小时和 96 小时的临床和实验室数据。我们还将采访患者以测量社会和行为变量。我们将使用这些额外数据来制定第二个预测规则，以帮助医生识别患者在治疗开始后可以安全进行早期急诊和出院。该项目是实际应用所获得的教学知识的理想工具，提供了深入的临床研究经验，并有望产生广泛的初步数据以全面扩展长期研究计划。我的临床研究、教学计划以及高级生物统计和建模课程将由高素质、多学科的人才团队监督。根据我完成的成果研究奖学金和以前的研究经验，这项提案将使我作为一名临床研究者成熟，制定 ADHF 决策的预测规则，并在具有巨大医疗保健系统影响的疾病过程中进行循证研究。 （摘要完）