Cardiovascular Disease Trends in the Elderly

描述(由申请人提供)：尽管心血管疾病(CVD)被认为是导致死亡的主要原因，但这个国家缺乏一个具有凝聚力、信息量大的监测系统，无法提供对国家护理模式的洞察，揭示国家随着时间的推移的趋势，并跟踪美国老年人的短期和长期患者结果。大多数国家对心血管疾病和预后的估计都是基于极少数社区研究或临床研究的外推率，这些研究受到规模、人口统计学或地理位置的限制。此外，结果衡量通常仅限于复发疾病或死亡，通常考虑短期结果(很少超过12至24个月)。相关的血管事件和非血管事件很少被考虑。这导致了巨大的数据差距。确定心血管疾病的模式和趋势，并确定不同群体在年龄、种族、性别、临床病史以及美国不同地理区域之间的差异和差异，应该是研究的首要任务。我们已经建立了一个以人口为基础的国家队列，将开始填补这些知识空白。老年心血管疾病趋势研究将持续12年，包括1991年至2003年期间因心血管疾病出院的所有按服务收费的医疗保险受益人。因此，这项研究有以下具体目标：(1)确定12年来心血管疾病的趋势，特别是按年龄、种族和性别分组以及地区；(2)确定心血管疾病住院患者的短期和长期结果；以及(3)确定医疗保险受益人的费用和结果的变化。这一职业发展奖将使应聘者建立更多的技能，将临床医学、流行病学、公共卫生、生物统计学和健康经济学的互补学科联系起来，以检查老年人的心血管疾病负担。这一独特的视角将为政策制定者和研究人员规划既往心血管疾病患者的医疗保健需求提供有价值的见解。

DESCRIPTION (provided by applicant): Despite the recognition of cardiovascular disease (CVD) as a leading cause of mortality, this country lacks a cohesive, informative surveillance system that can provide insights into national patterns of care, reveal national trends over time, and track short- and long-term patient outcomes for elderly Americans. Most national estimates of CVD and outcomes have been based on extrapolating rates from a very small number of community studies or clinical studies that are restricted in terms of size, demographics, or geography. In addition, outcome measures have most often been limited to recurrent disease or death, and typically consider short-term outcomes (rarely beyond 12 to 24 months). Related vascular events and nonvascular events are rarely considered. This has resulted in significant data gaps. Defining patterns and trends of CVD, and identifying differences and disparities among diverse groups in terms of age, race, gender, clinical history, as well as different geographic regions of the United States should be a top research priority. We have created a population-based national cohort that will begin to fill these gaps in knowledge. The Cardiovascular Disease Trends in the Elderly Study will span 12 years and include all fee-for-service Medicare beneficiaries discharged with CVD from 1991 through 2003. Accordingly, this study has the following specific aims: (1) Determine 12-year cardiovascular disease trends, especially by age, race, and gender subgroups, as well as region; (2) determine the short- and long-term outcomes for patients hospitalized with cardiovascular disease; and (3) determine the change in cost and outcomes for Medicare beneficiaries. This career development award will enable the candidate to build additional skills to link the complementary disciplines of clinical medicine, epidemiology, public health, biostatistics, and health economics to examine the burden of cardiovascular disease in the elderly. This unique perspective will provide valuable insights for policy makers and investigators in planning for the health care needs of patients with established cardiovascular disease.