Comorbidity and Functional Outcomes in Older Patients with Heart Failure

描述（由申请人提供）： 项目概要：心力衰竭（HF）是65岁或65岁以上老年人住院的首要原因;然而，我们的医疗系统在制定优化老年HF患者护理的策略方面进展缓慢。传统的以疾病为导向的模式是大多数HF研究和临床护理的基础，侧重于个体疾病。该模型未能考虑到广泛的合并症，包括通常给老年HF患者带来负担的损害（体能、认知、视觉、听力和心理状态）。这些损害可能会阻碍老年患者管理其疾病的能力，但合并症损害在HF文献和质量指标中仍然基本上不可见。在这个为期5年的奖项期间，Chaudhry博士将开展两个项目，以加强关于共病损伤和疾病如何影响老年HF患者功能结局的科学知识基础。 在第一个项目中，她将分析来自心血管健康研究的数据（目前已有超过10年的随访），以比较有和没有HF的老年人的长期功能结局，并确定共病损伤和疾病对功能障碍发作的相对贡献。在第二个项目中，她将进行一项前瞻性研究，以描述老年患者在HF住院时共病损伤和疾病的负担，并评估这些共病与出院后功能下降的关系。为了促进她的职业发展，Chaudhry博士将完成慢性病流行病学，纵向数据分析和数据管理的正式课程。这些活动，结合来自耶鲁大学老龄化项目/Pepper中心和Robert Wood约翰逊临床学者项目的导师的指导，将使Chaudhry博士能够建立一个独立的研究项目，以改善老年HF患者的护理。相关性：尽管每年花费数十亿美元用于照顾老年HF患者，但在过去十年中，这一人群的结局并未改善。拟议研究的结果有可能从根本上改变我们对HF的理解，从一种孤立的疾病转变为一种真正的老年心血管综合征。最终，这些结果将有助于指导发展更多的“以老年人为中心”的HF护理的基础上，共病损害的常规管理，并告知下一代的HF质量指标。

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.