Atrial Fibrillation in Sepsis: Patient Outcomes and Provider Practice Patterns

脓毒症中的心房颤动：患者结果和提供者实践模式

• 批准号: 9002852
• 负责人: Allan J. Walkey
• 金额: $ 16.96万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-12 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9002852
• 关键词: Acute; Address; Adult; Affect; Age; American; Anticoagulation; Atrial Fibrillation; Award; Benefits and Risks; Biometry; Cardiovascular system; Cause of Death; Cessation of life; Clinical; Collaborations; Critical Illness; Data; Data Set; Data Sources; Databases; Diagnosis; Disease; Drug Utilization; Educational process of instructing; Elderly; Epidemiologic Methods; Epidemiology; Foundations; Future; Geography; Goals; Health; Health Care Costs; Health Services; Heart Atrium; Heart Diseases; Heart Rate; Heart failure; Hematological Disease; Hemorrhage; Hospital Mortality; Hospitalization; Hospitals; Incidence; Inflammation; Inflammatory; Inpatients; Intervention; Ischemic Stroke; K-Series Research Career Programs; Knowledge; Leadership; Learning Skill; Literature; Lung diseases; Medicare; Mentors; Mentorship; Meta-Analysis; Metabolic; Methods; Mission; Modification; National Heart, Lung, and Blood Institute; Outcome; Outcomes and Health Services Research; Patient observation; Patient-Focused Outcomes; Patients; Pattern; Physicians; Positioning Attribute; Prevention; Procedures; Provider; Reporting; Research; Research Methodology; Risk; Risk Factors; Sampling; Sepsis; Solid; Stroke; Survivors; Syndrome; Systemic infection; Training; Variant; Writing; base; career; career development; clinical investigation; clinically relevant; cohort; comparative effectiveness; comparative efficacy; compare effectiveness; cost effectiveness; data management; demographics; effectiveness research; efficacy trial; evidence base; heart rhythm; hemodynamics; improved outcome; innovation; medical specialties; middle age; outcome forecast; programs; risk benefit ratio; sex; skills; skills training; sobriety; technique development; treatment strategy; trial design

DESCRIPTION (provided by applicant): Sepsis is a syndrome of infection and systemic inflammation that is a top 10 cause of death with increasing incidence affecting approximately 2 million Americans yearly. The inflammatory, hemodynamic, and metabolic abnormalities that characterize sepsis are also known triggers and risk factors for atrial fibrillation. Atrial fibrilation is a heart rhythm disturbance characterized by a loss of normal atrial contractility and rapid heart rates. The hypothesis that sepsis is a strong atrial fibrillation trigger is supported by the observation that patients hospitalized with severe sepsis (vs. non-severe sepsis) have a 6-fold increased risk of developing new-onset atrial fibrillation. Importantly, patients who develop new-onset AF during severe sepsis have significantly increased risk for in-hospital death and stroke. More than 1/2 of patients who develop atrial fibrillation during severe sepsis do not survive to hospital discharge. No data are available for prognostication of long term outcomes in patients with sepsis-associated, new-onset atrial fibrillation. Further, little evidence exists to weigh riss and benefits of complicated treatment decisions for atrial fibrillation during sepsis. In line with the National Heart, Lung, and Blood Institute's mission to promote the prevention and treatment of heart, lung, and blood disease, the current proposal will use complementary administrative claims data sources to determine long-term outcomes and compare effectiveness of practice patterns associated with new-onset atrial fibrillation occurring during sepsis. Through the Mentored Career Development Award, the candidate will develop skills necessary for transition to an independent research career, including training in advanced epidemiologic methods, health services/outcomes/observational comparative effectiveness research methods, advanced biostatistics/data management techniques, and development of leadership and writing expertise. The information produced from the proposed project will inform further comparative effectiveness and efficacy trials designed to directly inform clinical decisions for patients with atrial fibrillation during sepsis. In addition, the career development and training skills learned during the award will allow the candidate to build and expand upon the currently limited data sources available for the study of patients with sepsis.

描述（由申请人提供）：脓毒症是一种感染和全身性炎症综合征，是十大死亡原因，每年影响约200万美国人的发病率不断增加。炎症、血流动力学和代谢异常是脓毒症的特征，也是房颤的已知触发因素和风险因素。心房纤颤是一种心律紊乱，其特征是正常心房收缩力丧失和心率加快。脓毒症是一种强烈的房颤触发因素的假设得到了以下文献的支持： 观察到严重脓毒症住院患者（与非严重脓毒症相比）发生新发房颤的风险增加了6倍。重要的是，严重脓毒症期间新发AF的患者院内死亡和卒中的风险显著增加。在严重脓毒症期间发生房颤的患者中，超过1/2的患者无法存活至出院。没有数据可用于说明脓毒症相关新发房颤患者的长期结局。此外，几乎没有证据表明脓毒症期间房颤复杂治疗决策的风险和益处。符合 国家心脏、肺和血液研究所的使命是促进心脏、肺和血液疾病的预防和治疗，目前的提案将使用补充的行政索赔数据源来确定长期结果，并比较与脓毒症期间新发房颤相关的实践模式的有效性。通过指导职业发展奖，候选人将发展必要的技能过渡到一个独立的研究生涯，包括在先进的流行病学方法，卫生服务/结果/观察比较有效性研究方法，先进的生物统计学/数据管理技术，以及领导和写作专业知识的发展培训。拟议项目产生的信息将为进一步的比较有效性和疗效试验提供信息，这些试验旨在为脓毒症期间房颤患者的临床决策提供直接信息。此外，在获奖期间学到的职业发展和培训技能将使候选人能够建立和扩展目前有限的数据源，用于脓毒症患者的研究。