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

 描述（由申请人提供）：房颤（AF）影响520万美国人，超过75%的AF患者年龄在65岁或以上。权衡卒中风险与抗凝剂（AC）出血风险是AF管理的核心。老年房颤患者发生卒中和大出血的风险最高，通常会减少AC的处方。近年来，随着华法林以外的靶向特异性口服抗凝剂的引入，AF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以前被忽视的老年评估信息（例如，认知功能，跌倒风险），并确定其在临床上易于施用的关键要素，以及与重要的AC结果相关的关键要素（例如，出血、治疗范围内的时间[TTR]、患者报告的AC满意度）。我们将对从马萨诸塞州中部和佐治亚州5家门诊诊所招募的1,200例高卒中风险（CHA 2DS 2-VASc≥2）老年AF患者的多样化样本进行老年评估，每6个月一次，持续2年。建议项目的具体目标是：1。根据经验证的社会心理和认知功能以及虚弱程度的测量结果，将老年评估的组成部分与AC的使用和类型相关联，并比较AC使用者和非使用者中老年评估的要素如何随时间变化。2.在接受AC治疗的AF患者中，将基线时的老年评估指标与成功AC的指标（例如，出血、TTR和患者满意度），3.在接受AC治疗的AF患者中，将老年评估指标的变化与成功AC的指标（出血、TTR和患者满意度）相关联，并评价这种关联是否因AC类型而异。我们的研究结果将为新的和简约的风险分层提供重要信息 为老年房颤患者提供最佳抗凝治疗以及临床和生活质量结局。我们 还将通过编写一个简洁、易于使用的老年AF资源，以新颖且用户友好的方式传播我们的结果，该资源由关键的老年要素组成，所有这些要素都将在公共领域免费提供，并提供管理和解释说明。这个老年房颤资源将加速我们的研究结果的吸收，并增强SAGE-AF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.