Comorbidity and Functional Outcomes in Older Patients with Heart Failure

描述(由申请人提供)：项目摘要：心力衰竭(HF)是65岁或65岁以上老年人住院的头号原因；然而，我们的医疗系统在制定战略以优化老年HF患者的护理方面一直进展缓慢。传统的以疾病为导向的模式是大多数心力衰竭研究和临床护理的基础，专注于个别疾病。这个模型没有考虑到广泛的共病，其中包括经常给老年患者带来心力衰竭负担的损害(体能、认知、视力、听力和心理状态)。这些损伤可能会阻碍老年患者管理疾病的能力，但在HF文献和质量指标中，合并损伤仍然很大程度上是不可见的。在这项为期5年的奖项中，乔杜里博士将开展两个项目，以加强有关合并损伤和疾病如何影响老年心力衰竭患者功能结果的科学知识基础。 在第一个项目中，她将分析心血管健康研究(现已进行了10多年的跟踪调查)的数据，以比较患有和不患有心力衰竭的老年人的长期功能结果，并确定合并损伤和疾病对功能性残疾发病的相对贡献。在第二个项目中，她将进行一项前瞻性研究，以表征老年患者在入院时并发损害和疾病的负担，并评估这些并存与出院后功能下降的关系。为了促进她的职业发展，乔杜里博士将完成慢性病流行病学、纵向数据分析和数据管理方面的正式课程。这些活动，再加上耶鲁老年计划/胡椒中心和罗伯特·伍德·约翰逊临床学者计划的导师的指导，将使乔杜里博士能够建立一个独立的研究计划，以改善老年心力衰竭患者的护理。相关性：尽管每年花费数十亿美元护理老年心力衰竭患者，但在过去十年中，这一人群的结果并没有改善。拟议的研究结果有可能从根本上改变我们对心力衰竭的理解，从一种孤立的疾病转变为一种真正的老年心脏病综合征。最终，这些结果将有助于指导在共病损害常规管理的基础上发展更多以老年为中心的心力衰竭护理，并为下一代心力衰竭质量指标提供信息。

DESCRIPTION (provided by applicant): PROJECT SUMMARY: Heart failure (HF) is the number one cause of hospitalization among persons aged 65 years or older; yet our medical system has been slow to develop strategies to optimize the care of older patients with HF. The traditional disease-oriented model, which underlies most HF research and clinical care, focuses on individual diseases. This model fails to consider the broad spectrum of comorbidity, which includes impairments (in physical capacity, cognition, vision, hearing and psychological status) that often burden older patients with HF. These impairments may impede the ability of older patients to manage their illness, yet comorbid impairments remain largely invisible within the HF literature and quality indicators. Over the course of this 5-year award, Dr. Chaudhry will conduct two projects to enhance the scientific knowledge base about how comorbid impairments and diseases affect the functional outcomes of older patients with HF. In the first project, she will analyze data from the Cardiovascular Health Study (which now has over 10 years of follow-up) to compare the long-term functional outcomes of older persons with and without HF, and determine the relative contributions of comorbid impairments and diseases to the onset of functional disability. In the second project, she will conduct a prospective study to characterize the burden of comorbid impairments and diseases in older patients at the time of HF hospitalization and evaluate the relationship of these comorbidities to functional decline after hospital discharge. To enhance her career development, Dr. Chaudhry will complete formal coursework in chronic disease epidemiology, longitudinal data analysis, and data management. These activities, combined with the guidance of mentors from the Yale Program on Aging/Pepper Center and Robert Wood Johnson Clinical Scholars Program, will enable Dr. Chaudhry to establish an independent research program to improve the care of older patients with HF. RELEVANCE: Despite the billions of dollars spent each year caring for older patients with HF, outcomes have not improved in this population over the past decade. The results of the proposed research have the potential to fundamentally change our understanding of HF from an isolated disease to a true cardiogeriatric syndrome. Ultimately, these results will help to guide the development of more "gerocentric" HF care based on routine management of co-morbid impairments, and to inform the next generation of HF quality indicators.