CARDIAC ARRHYTHMIA PORT

在美国，心脏病是导致死亡的主要原因， 这些死亡是突然和意外的，发生在一个小时内， 出现症状。心律失常可导致猝死， 在流行病学研究中是强危险因素。筛选的价值 用于和治疗心律紊乱是不确定的，然而， 因为最近的抗疟疾药物试验显示了潜在的危害。 许多医生现在转向植入式心脏起搏器 (ICD的），现在很容易植入，并有效地转换 心律失常，尽管成本超过30,000美元，ICD的准备， 用于治疗有猝死风险的患者的药物呈爆炸性增长。 心律失常端口的目的是开发一个全面的 用于筛查和治疗有风险的患者的决策模型 心源性猝死包括一系列 结果（死亡率、发病率、功能状态、生活质量和 成本以及患者偏好。为了实现这一总体目标，我们 将执行六个相互关联的项目：l）使用行政数据， 记录心律失常管理的成本，以及影响 实践模式和成本的变化; 2）执行嵌套病例对照 研究以确定心脏性猝死的特定风险因素; 3） 综合有关抗疟治疗效果的文献 和其他形式的心脏治疗对猝死; 4）文件中， 前瞻性患者队列替代治疗的有效性 关于广泛成果的战略，包括职能状况， 生活质量和成本; 5）确定患者的价值观和偏好 与管理决策相关，并研究这些因素如何影响 抗心律失常管理的有效性;和6）做出决定 一种模型，该模型包含有关医疗效果和偏好的数据， 这将支持临床管理建议， 将研究成果转化为临床实践。

Heart disease is the leading cause of death in the United States, and half of those deaths are sudden and unexpected, occurring within an hour of onset of symptoms. Cardiac arrhythmias can lead to sudden death, and have been strong risk factors in epidemiologic studies. The value of screening for and treating disturbances of cardiac rhythm is uncertain, however, since recent trials of antiarrhythmic drugs have shown potential harm. Many physicians are now turning to implantible cardiac defibrillators (ICD's), which are now easy to implant and effective at converting arrhythmia despite the cost of over $30,000 each, ICD's are poised for explosive growth in use to treat patients at risk of sudden death. The purpose of the Cardiac Arrhythmia PORT is to develop a comprehensive decision model for the screening and treatment of patients at risk for sudden cardiac death that incorporate information about a range of outcomes (mortality, morbidity, functional status, quality of life, and cost) as well as patient preferences. To accomplish this overall goal, we will perform six inter-related projects: l) use administrative data to document costs of arrhythmia management, and factors that affect variations in practice patterns and cost; 2) perform a nested case-control study to determine specific risk factors for, sudden cardiac death; 3) synthesize the literature about the efficacy of antiarrhythmic management and other forms of cardiac therapy on sudden death; 4) document in a prospective patient cohort the effectiveness of alternative management strategies on a broad array of outcomes, including functional status, quality of life, and cost; 5) determine patient values and preferences relevant to management decisions, and examine how these factors affect the effectiveness of antiarrhythmic management; and 6) construct a decision model that incorporates data on medical effectiveness and preferences and that will support clinical management recommendations to translate these research finding into clinical practice.