B-Blocker effect on a range of health outcomes in older adults with CAD and COPD

B 受体阻滞剂对患有 CAD 和 COPD 的老年人的一系列健康结果的影响

• 批准号: 8013756
• 负责人: MARY E TINETTI
• 金额: $ 36.11万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8013756
• 关键词: Blocker; effect; range; health; outcomes

DESCRIPTION (provided by applicant): With this analytic epidemiologic study, we begin investigating situations in which the treatment of one condition may exacerbate other conditions or adversely affect other health outcomes. Despite potential harms to the large number of older individuals with multiple co-occurring health conditions, this topic has received little research attention. We explore the capability of using large national population-based cohorts and novel analytical techniques to compare the benefits and harms of different intervention strategies, across a range of health outcome domains, in complex older adults with multi-morbidity. To develop our strategy, we begin by investigating Beta-Blocker (2-Blocker) intensity in persons with co-occurring coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD). Once we have tested the method with this important clinical question, we will extent to other sets of conditions and medications. This project builds on our ongoing research on multi-morbidity that includes mapping disease-specific outcomes onto universal health outcomes, determining tradeoffs among competing conditions, and ascertaining the contribution of multiple co-occurring conditions to death and other health outcomes. Our methodological aim is to develop an innovative method for comparing different treatment strategies in situations in which the treatment of one condition could exacerbate other conditions or affect other health outcomes. Using our novel methods, we will test the hypothesis that, among comparable older adults with co- occurring CAD and COPD, greater 2-Blocker intensity is associated with fewer CV events and lower mortality but more frequent adverse pulmonary outcomes; worse dyspnea, fatigue, and activity levels and greater disability than no or lower 2-Blocker intensity. In secondary analyses, we will explore these aims in relevant subgroups defined by age, CAD and COPD severity, gender, race, and co-morbidity burden. Two national, population-based cohorts, the Medicare Current Beneficiary Survey and the Medical Expenditure Panel Survey will be studied (study sample 35,000-40,000). Both have a wealth of longitudinal participant-reported, medication, and claims/health care utilization data. This depth and breadth of data allows us to use innovative analytical techniques to assess the effects of treatments on disease-specific and universal health outcomes (e.g. disability, symptoms burden, functional limitations, and death), accounting for propensity to receive the treatment, and other confounders. We propose a new paradigm for quantifying the harms and benefits of treatments in complex older persons with multiple conditions. Our ultimate goal is to develop a method for determining the optimal treatments for older adults with multiple conditions that maximizes benefits and minimizes harms within the outcome domain(s) of highest priority for each patient. PUBLIC HEALTH RELEVANCE: Among persons with multiple chronic diseases, treatments for one disease may exacerbate co-occurring diseases or adversely affect overall health outcomes. We are exploring whether Beta-Blocker use in older adults with co-occurring coronary artery disease (CAD) and chronic obstructive pulmonary disease benefits cardiac outcomes but worsen pulmonary outcomes, symptoms, or activity levels. Study results can help determine the net benefit or harm of commonly recommended treatments among the growing number of older adults with multiple health conditions.

描述（由申请人提供）：通过这项分析流行病学研究，我们开始研究一种情况，在这种情况下，一种疾病的治疗可能加剧其他疾病或对其他健康结果产生不利影响。尽管对大量同时发生健康状况的大量老年人有潜在的伤害，但该主题几乎没有得到研究的关注。我们探讨了在具有多种多样的复杂老年人中，使用大型国家人群的同伙和新颖的分析技术来比较一系列健康结果领域的不同干预策略的益处和危害。 为了制定我们的策略，我们首先研究了冠状动脉疾病（CAD）和慢性阻塞性肺部疾病（COPD）的患者中的β受体阻滞剂（2阻滞剂）强度。一旦我们用这个重要的临床问题测试了该方法，我们将限制其他一组疾病和药物。该项目基于我们正在进行的多种多样的研究，其中包括将特定疾病的结果映射到普遍的健康结果上，确定竞争状况之间的权衡，并确定多种共同存在的疾病对死亡和其他健康状况的贡献。 我们的方法论目的是开发一种创新方法，以比较在一种情况下治疗可能加剧其他疾病或影响其他健康结果的情况下的不同治疗策略。使用我们的新方法，我们将检验以下假设：在具有同类的CAD和COPD的可比老年人中，更大的2受阻滞剂强度与更少的CV事件和较低的死亡率相关，但较低的肺部不良肺结果。呼吸困难，疲劳和活性水平较差，而残疾人的残疾程度则比没有或更低的2障碍物强度更大。在次要分析中，我们将在年龄，CAD和COPD严重性，性别，种族和合并症负担定义的相关亚组中探索这些目标。 将研究两个国家基于人口的同类同伙，Medicare当前的受益人调查和医疗支出小组调查将进行研究（研究样本35,000-40,000）。两者都有大量的纵向参与者报告，药物和索赔/医疗保健利用数据。数据的深度和广度使我们能够使用创新的分析技术来评估治疗对疾病特异性和普遍健康结果的影响（例如残疾，症状负担，功能局限性和死亡），考虑接受治疗的倾向以及其他混淆者的倾向。我们提出了一个新的范式，用于量化具有多种条件的复杂老年人的治疗危害和益处。我们的最终目标是开发一种确定具有多种疾病的老年人的最佳治疗方法，这些方法可最大程度地提高收益并最大程度地减少每个患者最高优先级的危害。 公共卫生相关性：在患有多种慢性疾病的人中，一种疾病的治疗可能会加剧同时发生的疾病或对整体健康状况产生不利影响。我们正在探索在患有冠状动脉疾病（CAD）和慢性阻塞性肺部疾病的老年人中使用β受体阻滞剂是否有益于心脏结局，但会使肺癌，症状或活动水平恶化。研究结果可以帮助确定越来越多的健康状况的老年人中常见治疗的净益处或危害。