A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and Polypharmacy

项目总结 候选人：我的职业目标是改善患有多种慢性病的老年人的健康状况 通过制定和严格测试合理的策略来改善用药处方 并成为老年心脏病学的独立临床研究员和全国领先者。这 作为一名心力衰竭心脏病专家，这一领域对我来说特别相关，因为我关心的是几乎 普遍患有多种慢性病和多药并存。我作为这方面的新兴领导者的过往记录 该领域的证据是多份主要作者和资深作者的手稿，4名首席调查员获得赠款 包括GEMSSTAR，我作为威尔·康奈尔心力衰竭基金会主任的职位 老年保留性弹射(HFpEF)计划，以及我作为美国大学 心脏病学老年心脏病科早期职业专家工作组。导师和环境： 该项目将在4名资金雄厚的调查人员的指导下进行，他们将贡献他们的 老年医学(Mark Laches)、老年心脏病学(Mathew Maurer)、 实施科学(Monika Safford)和N-of-1试验(Ian Kronish)。取消处方的顾问，共享 决策和生物统计将提供更多的内容专门知识，以确保 提出的项目，并促进了我的职业发展。该项目将在支持性的 威尔·康奈尔医学院的环境，这表明了我作为一名 在过去的几年里，他一直是临床医生和研究员。指导性研究项目：尽管它是不可或缺的一部分 在以患者为中心和目标一致的处方实践中，取消处方很少被纳入临床 由于几个障碍的练习。为了改善以患者为中心的用药管理，有必要 制定能够克服这些障碍的流程。这项提案的目标是确定N- Of-1试验-作为一种务实的以患者为中心的药物优化方法，可以克服关键 停药障碍--可增加患者对继续或继续开药的决定的信心 停止服药。为了实现这一目标，我将：1)确定一项可行和务实的议定书的关键特征 使用利益相关者参与的迭代设计方法取消N-of-1试验的处方；以及2)确定 调整后的N-of-1方案在患者决策信心和停药方面的初步有效性，以及 3)确定将经过调整的N-of-1方案应用于现实世界临床的促进者和障碍 通过进行第一类混合有效性-实施试验进行实践。我将通过使用？？实现这些目标- 射血分数保留的心力衰竭阻滞剂(HFpEF)作为老年高血压患者的原型 多发病和多药联用。这项建议将为未来的多中心随机对照试验提供参考 专注于改善患者报告的结果，并为我提供了一个形成机会来获得 在以患者为中心的药物管理方面成为领先的研究人员所需的知识和技能。

PROJECT SUMMARY Candidate: My career goal is to improve the wellbeing of older adults with multiple chronic conditions and polypharmacy by developing and rigorously testing rational strategies to improve medication prescribing practices; and to become an independent clinician investigator and national leader in Geriatric Cardiology. This area is particularly relevant for me as a heart failure cardiologist, as I care for older adults who almost universally have multiple chronic conditions and polypharmacy. My track record as an emerging leader in this area is evidenced by multiple lead- and senior-author manuscripts, 4 grants as the Principal Investigator including a GEMSSTAR, my position as the Founding Director of the Weill Cornell Heart Failure with Preserved Ejection (HFpEF) Program for the Aging, and my role as the Chair of the American College of Cardiology Geriatric Cardiology Section Early Career Professionals Working Group. Mentors and Environment: This project will be conducted under the mentorship of 4 well-funded investigators who will contribute their complementary expertise in Geriatrics (Mark Lachs), Geriatric Cardiology (Mathew Maurer), Implementation Science (Monika Safford), and N-of-1 trials (Ian Kronish). Advisors in deprescribing, shared decision making, and biostatistics will provide additional content expertise to ensure the success of the proposed project and catalyze my career development. This project will take place within the supportive environment of Weill Cornell Medicine, which has demonstrated a deep commitment to my development as a clinician-investigator for the past several years. Mentored Research Project: Despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is seldom incorporated into clinical practice due to several barriers. To improve patient-centered medication management, there is a need to develop processes that can overcome these barriers. The objective of this proposal is to determine whether N- of-1 trials—as a pragmatic patient-centered approach to medication optimization that can overcome key barriers of deprescribing— can lead to increased patient confidence regarding the decision to continue or discontinue a medication. To achieve this, I will: 1) determine key features of a feasible and pragmatic protocol for deprescribing N-of-1 trials using a stakeholder-engaged iterative design approach; and 2) determine the preliminary effectiveness of an adapted N-of-1 protocol on patient decision confidence and deprescribing, and 3) determine the facilitators and barriers of implementing an adapted N-of-1 protocol into real-world clinical practice by conducting a type-1 hybrid effectiveness-implementation trial. I will achieve these aims by using ß- blocker in heart failure with preserved ejection fraction (HFpEF) as a prototype for older adults with multimorbidity and polypharmacy. This proposal will inform a future multicenter randomized controlled trial focused on improving patient-reported outcomes, and provide a formative opportunity for me to obtain the knowledge and skills necessary to become a leading researcher on patient-centered medication management.