Patterns of Health Care Use, Treatment & Outcomes in Atrial Fibrillation: PATH-AF

描述（由申请人提供）：心房颤动（AF）是心血管疾病发病率和死亡率的主要来源，也是一个重要的公共卫生问题。据估计，仅美国的房颤患病率就将从2001年的230万上升到2050年的600多万。虽然我们对房颤的患病率和临床后果的了解是健全的，但仍然存在重要的差距。首先，房颤治疗的临床指南已经存在，但是在社区环境中房颤患者的护理在多大程度上符合这些指南，目前尚不清楚。此外，护理如何因年龄、性别、种族、地理（例如，地区、城市与农村位置）和时间的不同而有所不同还未得到充分研究。其次，在随机临床试验中，许多新技术与发病率和死亡率的改变有关，但这些技术在常规临床实践中的应用程度尚不清楚。最后，我们几乎没有经验证据表明用于治疗房颤的资源如何转化为改善的结果。拟议项目“房颤的医疗使用模式、治疗和结果：PATH-AF”的目的是提高我们对上述问题的理解。我们的工作有三个具体目标：目标1将记录临床实践反映既定指南的程度，并将研究AF的基于指南的护理和标准护理如何随年龄、性别、种族、地理和时间而变化。目的2将分析使用新兴技术来监测和治疗房颤患者，包括使用家庭监测设备来测量INR和使用射频导管消融。同样，在亚组分析中，我们将根据年龄、性别、种族和地理位置检查使用差异。目的3将检查房颤患者的医疗保健使用、结果和成本之间的关系。总之，房颤是人群发病率和死亡率的主要因素。我们汇集了一个多机构、多学科的团队，具有房颤、卫生服务研究、流行病学、初级保健、心力衰竭和统计学方面的专业知识。我们建议利用与索赔相关的现有队列和登记，提供美国房颤医疗保健使用、治疗和结果的全面图景。研究结果将促进我们对“现实世界”房颤治疗的理解，并建立使用队列索赔相关数据集的能力，为当前关于医疗保健价值的讨论提供信息。

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) is a major source of cardiovascular disease morbidity and mortality and an important public health problem. It is estimated that the prevalence of AF in the U.S. alone will rise from 2.3 million in 2001 to more than 6 million in 2050. Although our understanding of the prevalence and clinical consequences of AF is sound, important gaps remain. First, clinical guidelines for the management of AF exist, but the extent to which the care of patients with AF in community settings is consistent with these guidelines and is unclear. In addition, how care varies by age, sex, race, geography (e.g., region, urban vs. rural location) and over time is understudied. Second, a number of new technologies have been associated with altered morbidity and mortality in randomized clinical trials, but the extent to which those technologies are used in routine clinical practice is unknown. Finally, we have little empirical evidence about how the resources expended to treat AF translate into improved outcomes. The objective of the proposed project, Patterns of Healthcare Use, Treatment & Outcomes of Atrial Fibrillation: PATH-AF, is to improve our understanding of the aforementioned issues. Our efforts are organized under three Specific Aims: Aim 1 will document the extent to which clinical practice reflects established guidelines and will examine how guidelines-based care and standard care for AF varies by age, sex, race, geography and over time. Aim 2 will analyze the use of emerging technologies to monitor and treat AF patients, including the use of home monitoring devices to measure INR and the use of radiofrequency catheter ablation. Again, in subgroup analyses we will examine differential use by age, sex, race, and geography. Aim 3 will examine the relations between health care use, outcomes and costs in patients with AF. In summary, AF is a major contributor to morbidity and mortality in the population. We bring together a multi- institutional, multidisciplinary team with expertise in AF, health services research, epidemiology, primary care, heart failure, and statistics. We propose to leverage existing cohorts and registries linked with claims to provide a comprehensive picture of healthcare use, treatment, and outcomes of AF in the U.S. The findings will advance our understanding of the treatment of AF in "real-world" settings and build the capacity to use cohort-claims linked data sets to inform current discussions about value in health care. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to the public health in two ways. First, it will provide a comprehensive understanding of the health care of patients with atrial fibrillation in the United States. Second, it will directly answer critical questions of how investments in health care for patients with atrial fibrillation are directly linked to survival and health.