Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF)

 描述(申请人提供)：房颤(房颤)影响520万美国人，超过75%的房颤患者年龄在65岁或以上。权衡卒中风险和抗凝剂(AC)的出血风险是房颤治疗的核心。老年房颤患者中风和大出血的风险最高，通常会减少AC的处方。近年来，随着华法林以外靶向特异性口服抗凝剂的引入，房颤的治疗也变得更加复杂。在拟议的房颤老年因素系统性评估(SAGE-AF)研究中，我们的总体目标是通过评估老年评估中以前被忽视的信息(例如认知功能、跌倒风险)，并确定其可在临床上使用且与重要的AC结果相关的关键因素(例如出血、在治疗范围内的时间[TTR]、患者报告的AC满意度)来增强老年房颤患者的AC决策。我们将在两年内每6个月对1,200名中风高危老年房颤患者(CHA2DS2-VASc≥2)进行老年评估，这些患者来自马萨诸塞州和佐治亚州中部的5家门诊诊所。拟议项目的具体目标是：1.根据有效的心理社会和认知功能和脆弱程度的测量，将老年评估的组成部分与AC的使用和类型联系起来，并比较AC使用者和非AC使用者的老年评估要素随时间的变化。2.在接受AC的房颤患者中，将基线的老年评估措施与成功的AC的指标(例如出血、TTR和患者满意度)联系起来；3.在接受AC的AF患者中，将老年评估措施的变化与成功的AC的指标(出血、TTR和患者满意度)联系起来，并评估这种联系是否因AC类型而异。我们的发现将为新的和简约的风险分层提供重要的信息 以获得最佳抗凝效果以及老年房颤患者的临床和生活质量。我们 还将以一种新颖和用户友好的方式传播我们的结果，根据我们的结果准备一个简洁、易于使用的老年房颤资源，其中包括关键的老年元素，所有这些元素都将在公共领域免费获得，以及管理和解释说明。这一老年房颤资源将加速我们的研究结果，并增强SAGE-房颤的临床影响。

 DESCRIPTION (provided by applicant): Atrial fibrillation (AF) affects 5.2 million Americans and over 75% of AF patients are 65 years or older. Weighing stroke risk against risk of bleeding from anticoagulants (AC) is central to AF management. Older AF patients are at highest risk for stroke and major bleeding, often curtailing prescription of AC. Therapy for AF has also become more complex in recent years with the introduction of target specific oral anticoagulants beyond warfarin. In the proposed Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, our overall objective is to enhance AC decision-making in older patients with AF by assessing previously neglected information that is part of a geriatric assessment (e.g., cognitive function, fall risk) and identifying its key elements amenable to administration in the clinic and associated with important AC outcomes (e.g., bleeding, time in therapeutic range [TTR], patient-reported AC satisfaction). We will conduct geriatric assessments every 6 months for 2 years in a diverse sample of 1,200 older AF patients at high stroke risk (CHA2DS2-VASc≥2) recruited from 5 ambulatory clinics in Central MA and GA. The specific Aims of the proposed project are: 1. Relate components of a geriatric assessment, based on validated measures of psychosocial and cognitive function and frailty, to use and type of AC, and compare how elements of the geriatric assessment change over time in AC users and non-users. 2. Among AF patients receiving AC, relate geriatric assessment measures at baseline to indicators of successful AC (e.g., bleeding, TTR, and patient satisfaction), 3. Among AF patients receiving AC, relate change in geriatric assessment measures to indicators of successful AC (bleeding, TTR and patient satisfaction) and evaluate whether this association varies by AC type. Our findings will contribute important information on novel and parsimonious risk stratifiers for optimal anticoagulation and clinical and quality of life outcomes in older patients with AF. We will also disseminate our results in a novel and user-friendly was by preparing a concise, easy to use geriatric AF resource based on our results that is comprised of key geriatric elements, all of which will be freely available in the public domain, and instructions for administration and interpretation. This Geriatric AF Resource will accelerate the uptake of our findings and enhance the clinical impact of SAGE-AF.