Heart Failure: Epidemiology & Outcomes in the Elderly

描述（由申请人提供）：心力衰竭（HF）在老年人中呈上升趋势，用于治疗该疾病的资源占医疗保险支出的比例越来越大。尽管有这些趋势，但我们对老年心衰患者知之甚少，治疗是否反映循证指南，如何使用治疗服务，以及治疗是否能改善结果。我们目前对老年人心衰的认识受到几个因素的限制。首先，现有的以人群为基础的心衰患者观点依赖于相对较少患者的地理限制研究。其次，有详细的心衰治疗临床指南，但老年心衰患者的护理是否遵循这些指南尚不清楚。第三，许多治疗方法与老年人发病率和死亡率的改善有关，但这些治疗方法在老年患者中的应用程度尚不清楚。第四，我们几乎没有经验证据表明在现实环境中使用这些疗法会改善结果。建议项目的目的是提高我们对上述四个问题的理解。目的1：研究1997年至2006年间老年人心力衰竭的流行病学，使用全国医疗保险受益人样本。目的2：评估从最初诊断到随访的心力衰竭治疗中基于指南的护理的使用。目的3：分析一段时间以来心衰患者使用器械治疗的情况。目的4：评估心衰患者医疗保健利用与预后之间的关系。我们将通过使用由经验丰富的多学科研究团队开发的分析策略对具有全国代表性的纵向数据进行分析来实现这些目标，这些分析策略反映了临床心脏病学、卫生服务研究、卫生经济学和统计学的观点。在本研究的结论中，我们将对美国老年人心力衰竭有一个全面的了解，以及对HF患者的医疗保健投资如何与生存和健康直接相关。

DESCRIPTION (provided by applicant): Heart failure (HF) is on the rise in the elderly, and resources expended to treat the disease represent an increasing proportion of Medicare expenditures. Despite these trends, we know surprisingly little about HF in the elderly who develops the disease, whether treatment reflects evidence-based guidelines, how therapeutic services are used, and whether the therapies lead to improved outcomes. Our current understanding of HF in the elderly is limited by several factors. First, existing population-based views of patients with HF rely on geographically limited studies of relatively few patients. Second, detailed clinical guidelines for the management of heart failure exist, but it is unclear whether the care of elderly patients with HF, in fact, adheres to these guidelines. Third, a number of therapies have been associated with improved morbidity and mortality in the elderly, but the extent to which these therapies are being used in elderly patients is unknown. Fourth, we have little empirical evidence that the use of these therapies in real-world settings translates into improved outcomes. The objective of the proposed project is to improve our understanding of the aforementioned four issues. Our efforts are organized under four Specific Aims: Aim 1: To study the epidemiology of heart failure among the elderly, from 1997 through 2006, using a national sample of Medicare beneficiaries. Aim 2: To assess the use of guidelines-based care for the treatment of heart failure from the time of initial diagnosis through follow-up. Aim 3: To analyze the use of device-based therapies in the treatment of HF patients over time. Aim 4: To estimate the relationship between health care utilization and outcomes in patients with HF. We will accomplish these aims by conducting analyses of nationally-representative longitudinal data using analytic strategies developed by an experienced, multidisciplinary research team that reflects the perspectives of clinical cardiology, health services research, health economics, and statistics. At the conclusion of this study, we will have a comprehensive understanding of heart failure in elderly Americans and how investments in health care for patients with HF are directly linked to survival and health.