Cardiovascular Disease Trends in the Elderly

描述（由申请人提供）：尽管心血管疾病（CVD）被认为是死亡的主要原因，但美国缺乏一个有凝聚力的、信息丰富的监测系统，该系统可以提供对国家护理模式的见解，揭示国家随时间的趋势，并跟踪美国老年人的短期和长期患者结局。大多数国家对心血管疾病和结局的估计是基于从数量非常少的社区研究或临床研究中推断出的发生率，这些研究在规模、人口统计学或地理方面受到限制。此外，结局指标通常仅限于疾病复发或死亡，通常考虑短期结局（很少超过12至24个月）。很少考虑相关血管事件和非血管事件。这造成了重大的数据缺口。定义CVD的模式和趋势，并确定年龄，种族，性别，临床病史以及美国不同地理区域的不同群体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，它将开始填补这些知识空白。老年人心血管疾病趋势研究将持续12年，包括1991年至2003年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，本研究有以下具体目标：（1）确定12年心血管疾病趋势，特别是年龄，种族和性别亚组以及地区;（2）确定心血管疾病住院患者的短期和长期结局;（3）确定医疗保险受益人的成本和结局变化。该职业发展奖将使候选人能够建立额外的技能，将临床医学，流行病学，公共卫生，生物统计学和卫生经济学的互补学科联系起来，以研究老年人心血管疾病的负担。这种独特的视角将为政策制定者和研究人员提供有价值的见解，以规划患有心血管疾病的患者的医疗保健需求。

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.