Comparative effectiveness of catheter ablation vs medical therapy for atrial fibr

描述(由申请人提供)：这项建议包括一个为期五年的培训计划，重点是为詹姆斯·V·弗里曼，医学博士，公共卫生硕士，硕士，为在以患者为导向的学术心血管医学领域的独立职业生涯做准备。这项建议旨在传授申请者所需的技能和知识，以实现其长期目标，即为心律失常患者，特别是心房颤动患者提供最佳临床治疗策略的见解。申请人的直接培训目标是掌握基础临床研究方法，进行将扩大他对先进方法的理解的课程工作，发展自主运作所需的管理技能，并组成使他能够作为独立研究人员获得资金的工作体系。在他的长期导师Mark Hlatky和Alan Go的指导下，以及精心挑选的高级调查顾问委员会的指导下，他将拥有实现这些目标并过渡到独立的资源和支持。在美国，有超过230万的成年人患有房颤，这一数字预计将增加到 到2050年至少达到560万。导管消融术用于房颤，使用射频能量或冷冻疗法电隔离肺静脉并消除心律失常灶。 一种新的疗法，目前在美国每年用于治疗5万名患者，在欧洲每年用于治疗6万名患者。随机研究表明，房颤消融可以减轻心律失常负担，提高生活质量，但该手术也与1-10%的手术并发症有关。到目前为止，还没有随机研究证明该手术对死亡、缺血性中风、颅内出血和住院的长期影响，正在进行的一项随机研究包括非常精选的试验人群，并面临重大的患者登记挑战。我们建议对真实的房颤患者进行一系列分析，以填补与房颤消融相关的一些主要证据空白。拟议的项目将使用标准和创新的方法来分析北加州和南加州Kaiser Permanente(两个医疗保健系统，超过650万人)的临床数据和一项新的横断面调查研究，以实现四个具体目标：1)确定房颤消融是否与房颤患者的长期死亡率、缺血性中风、颅内出血和住院有关；)确定与房颤消融相关的与手术相关的不良安全事件的风险、这些不良事件的预测因素以及这些事件后的复发住院率和死亡率；3)结合死亡、缺血性卒中、颅内出血和住院的长期估计，评估房颤消融的成本-效果；4)评估决定接受房颤消融的以患者为中心的特征和消融治疗的障碍。

DESCRIPTION (provided by applicant): This proposal entails a five-year training program focused on preparing James V Freeman, MD, MPH, MS, for an independent career in patient-oriented academic cardiovascular medicine. This proposal aims to impart the skills and knowledge required for the applicant to achieve his long-term goal of contributing insights into the best clinical treatment strategies for patients with cardiac arrhythmias, and particularly atril fibrillation. The applicant's immediate training objectives are to master fundamental clinical research methods, perform coursework that will expand his understanding of advanced methods, develop administrative skills required to function autonomously, and compose a body of work that will enable him to obtain funding as an independent investigator. Under the guidance of his long-term mentors, Mark Hlatky and Alan Go, as well as a carefully selected advisory committee of senior investigators, he will have the resources and support to achieve these goals and transition to independence. PROJECT DESCRIPTION Atrial fibrillation (AF) affects over 2.3 million adults in the United States and this number is projected to increase to at least 5.6 million by 2050. Catheter ablation for atrial fibrillation (AF), using radiofrequency energy or cryotherapy to electrically isolate the pulmonary veins and eliminate arrhythmia foci, is a new therapy that is currently used to treat 50,000 patients per year in the United States and 60,000 patients per year in Europe. Randomized studies suggest that AF ablation may decrease arrhythmia burden and improve quality of life, but the procedure has also been associated with a 1-10% rate of procedural complications. No randomized studies to date have demonstrated the long term impact of the procedure on death, ischemic stroke, intracranial hemorrhage and hospitalization and the one ongoing randomized study includes a very selected trial population and has had significant patient enrollment challenges. We propose a series of analyses in real- world patients with AF, to close some of the major evidence gaps related to AF ablation. The proposed project will use standard and innovative methods to analyze clinical data from Kaiser Permanente Northern California and Southern California (two health care systems for over 6.5 million people) and a novel cross-sectional survey study to achieve four specific aims: 1) to establish whether atrial fibrillation ablation is associated with long-term mortality, ischemic stroke, intracranial hemorrhage and hospitalization in patients with atrial fibrillation; ) to determine the risk of procedure-related adverse safety events associated with atrial fibrillatio ablation, the predictors of these adverse events, and the rate of recurrent hospitalization and death after these events; 3) to estimate the cost-effectiveness of atrial fibrillation ablation incorporating long-term estimates of death, ischemic stroke, intracranial hemorrhage and hospitalization; 4) to assess patient-centered characteristics which inform the decision to undergo atrial fibrillation ablation and barriers to treatment with ablation.