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Improving Syncope Risk Stratification in Older Adults

改善老年人晕厥风险分层

基本信息

批准号：
9222035
负责人：
Benjamin C Sun
金额：
$ 72.47万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-02-01 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9222035
关键词：
Accident and Emergency department Address Admission activity Age Algorithms Bayesian Method Biological Markers Cardiac Cardiac Death Caring Cause of Death Cessation of life Characteristics Clinical Contractor Data Decision Making Diagnostic Diagnostic tests Elderly Electrocardiogram Emergency Department evaluation Emergency department visit Enrollment Evaluation Event Expenditure Goals Health Care Costs Hospital Costs Hospitalization Incidence Inpatients Lead Medical Medicare Methods Modeling Observational Study Outcome Patient Admission Patient risk Patients Pattern Patterns of Care Physicians Publishing Quality of life Recovery Research Retrospective Studies Risk Risk Assessment Risk stratification Syncopal Episodes Syncope Syndrome Testing Therapeutic Uncertainty Unconscious State United States Validation Work base cost evidence base health service use high risk high risk population improved innovation mortality novel older patient predictive modeling pressure prospective public health relevance tool virtual

项目摘要

DESCRIPTION (provided by applicant): There are 740,000 annual events of syncope (transient loss of consciousness) that lead to an emergency department (ED) visit, resulting in 250,000 admissions and $2.4 billion in yearly hospital costs. There are currently no effective prediction tools to identify older patients (agee60 years) who may be at risk for subsequent cardiac death or serious cardiac events. As a result, up to 85% of older adults with syncope are hospitalized for diagnostic evaluation. However, there is no evidence that admission improves diagnostic yield, quality-of-life, or mortality. Fundamental problems with the existing paradigm of care include inaccurate risk assessment and the lack of an evidence base to match predicted risk with appropriate clinical actions. Furthermore, existing research is virtually silent on how t risk stratify and evaluate older adults, who disproportionately account for diagnostic uncertainty, health service use, and serious outcomes. As a result, practice patterns have not changed over the past 30 years. Mounting pressures to constrain health care costs increase the topicality of this problem, and syncope was recently identified as one of the top conditions targeted by Medicare Recovery Audit Contractors for repossession of medically unnecessary inpatient expenditures. Innovative care models must be developed to improve the efficiency and value of the ED evaluation. To address these needs, we propose a prospective, observational study of 3,700 older adults with unexplained syncope enrolled from four emergency departments. Our specific hypotheses are that: 1.) current patterns of care are costly with low clinical benefit; 2. explicit criteria will improve risk stratification compared to unstructured physician assessment and published risk models; and 3.) risk-based decision-making can safely reduce costs compared to existing care. To assess these hypotheses, our proposal has the following sequential Aims: Specific Aim 1. Describe rates, diagnostic yield, therapeutic yield, and costs of diagnostic admission and testing associated with existing care. Specific Aim 2. Derive and validate a novel risk prediction model for 30-day cardiac death and serious cardiac outcomes after unexplained syncope. Specific Aim 3. Estimate diagnostic yield and costs of implementing risk-based decision algorithms. Our study will result in innovative care algorithms for a common and costly syndrome, and completion of our Aims will facilitate a paradigm shift in the evaluation of syncope in older adults.

描述（由申请人提供）：每年有 740,000 起晕厥（短暂意识丧失）事件导致急诊室 (ED) 就诊，导致 250,000 人入院，每年的医院费用为 24 亿美元。目前尚无有效的预测工具来识别可能面临后续心源性死亡或严重心脏事件风险的老年患者（60 岁）。因此，高达 85% 的晕厥老年人需要住院接受诊断评估。然而，没有证据表明入院可以提高诊断率、生活质量或死亡率。现有范式的根本问题护理包括不准确的风险评估以及缺乏将预测风险与适当的临床行动相匹配的证据基础。此外，现有的研究实际上没有提及如何对老年人进行风险分层和评估，老年人过多地考虑了诊断的不确定性，卫生服务的使用和严重后果。因此，过去30年来，实践模式没有改变。限制医疗保健费用的压力越来越大，增加了这个问题的话题性，晕厥最近被确定为医疗保险恢复审计承包商收回医疗上不必要的住院支出的首要条件之一。必须开发创新的护理模式，以提高急诊评估的效率和价值。为了满足这些需求，我们提议对来自四个急诊科的 3,700 名患有不明原因晕厥的老年人进行一项前瞻性观察性研究。我们的具体假设是：1.）当前的护理模式成本高昂，临床效益低； 2. 与非结构化的医生评估和已发布的风险模型相比，明确的标准将改善风险分层； 3.) 与现有护理相比，基于风险的决策可以安全地降低成本。为了评估这些假设，我们的提案有以下连续目标：具体目标 1. 描述与现有护理相关的诊断入院和检测的费率、诊断率、治疗率以及成本。具体目标 2. 推导并验证一种新的风险预测模型，用于预测不明原因晕厥后 30 天心源性死亡和严重心脏结局。具体目标 3. 估计实施基于风险的决策算法的诊断率和成本。我们的研究将为一种常见且昂贵的综合征带来创新的护理算法，并且完成我们的目标将促进老年人晕厥评估的范式转变。

项目成果

期刊论文数量（25）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department.

QTc 延长是到急诊科就诊的老年晕厥患者 30 天严重后果的标志。

DOI：
10.1016/j.ajem.2018.07.022
发表时间：
2019
期刊：
The American journal of emergency medicine
影响因子：
0
作者：
White,JenniferL;Chang,AnnaMarie;Hollander,JuddE;Su,Erica;Weiss,RobertE;Yagapen,AnnickN;Malveau,SusanE;Adler,DavidH;Bastani,Aveh;Baugh,ChristopherW;Caterino,JeffreyM;Clark,CarolL;Diercks,DeborahB;Nicks,BretA;Nishijim
通讯作者：
Nishijim

Syncope Risk Stratification in the Emergency Department: Another Step Forward.

DOI：
10.1111/acem.13036
发表时间：
2016-08
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
Nicks BA;Hiestand BC
通讯作者：
Hiestand BC

Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?

DOI：
10.1111/acem.13709
发表时间：
2019-05-01
期刊：
ACADEMIC EMERGENCY MEDICINE
影响因子：
4.4
作者：
Clark, Carol L.;Gibson, Thomas A.;Sun, Benjamin C.
通讯作者：
Sun, Benjamin C.

ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope.

患有晕厥的老年人心律失常的心电图预测因素。

DOI：
10.1016/j.annemergmed.2017.11.014
发表时间：
2018
期刊：
Annals of emergency medicine
影响因子：
6.2
作者：
Nishijima,DanielK;Lin,AmberL;Weiss,RobertE;Yagapen,AnnickN;Malveau,SusanE;Adler,DavidH;Bastani,Aveh;Baugh,ChristopherW;Caterino,JeffreyM;Clark,CarolL;Diercks,DeborahB;Hollander,JuddE;Nicks,BretA;Shah,ManishN;Stiffl
通讯作者：
Stiffl

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