Atrial fibrillation, functional decline, and arrhythmia detection in older adults

描述（由申请人提供）：心房颤动（AF）具有很高的发病率和死亡率，主要是一种高龄疾病。亚临床房颤导致老年人衰弱。关于房颤与身体机能和功能状态的关系的研究明显有限，建立了与年龄相关的不良衰退指标。我们的中心假设是房颤对老年人身体表现和功能状态的下降有重要影响。我们的长期目标是双重的：检查AF如何加剧功能限制，并最终确定早期识别亚临床AF是否可以减轻其对这些过程的影响。目前的研究将在健康、衰老和身体组成（Health ABC）研究中检查房颤与功能评估的横断面和前瞻性关系，该研究包括3075名功能良好的老年人（70-79岁）。作为补充目的，该研究将开展一项创新性的试点和可行性研究，从波士顿大学老年医学家庭护理项目（平均年龄84.2岁，54%是非裔美国人）中选择一组居家的老年人，检查亚临床房间隔。目的1将在基线检查和第4,6,8和10年的健康ABC中检查房颤与身体表现和功能状态的横断面关系。目的2将确定房颤与健康ABC检查中身体表现和功能状态测量的纵向变化的潜在关系。目标3将在家中老年人（n=100）中使用不显眼的7天心律监测仪，建立检测亚临床房颤的试点和可行性数据。拟议的研究将填补重要空白

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) conveys profound morbidity and mortality and is principally a disease of advanced age. Subclinical AF results in debilitating outcomes in older adults. There has been markedly limited study of the relation of AF to physical performance and functional status, established metrics of adverse age-related decline. Our central hypothesis is that AF contributes significantly to declining physical performance and functional status in older adults. Our long-term goals are two-fold: to examine how AF exacerbates functional limitations, and ultimately to determine if earlier identification of subclinical AF can mitigate its impact on such processes. The present investigations will examine the cross-sectional and prospective relations of AF to functional assessments in the biracial Health, Aging, and Body Composition (Health ABC) Study, consisting in 3,075 well-functioning older adults (70-79 years). As a complementary aim, the investigations will develop an innovative pilot and feasibility study examining subclinical AF in a cohort of home-bound older adults selected from the Boston University Geriatrics Home-Care Program (mean age 84.2, 54% African American). Aim 1 will examine the cross-sectional relations of AF to physical performance and functional status in Health ABC at the baseline exam and years 4, 6, 8 and 10. Aim 2 will determine the prospective relation of AF to longitudinal changes in measures of physical performance and functional status across Health ABC exams. Aim 3 will employ an unobtrusive 7-day cardiac rhythm monitor in home-bound older adults (n=100), establishing pilot and feasibility data for detection of subclinical AF. The proposed studies will fill important gaps in AF and geriatric epidemiology. Determining the relation of AF to age-related decline in physical performance and functional status has important implications for earlier detection and treatment of AF to prevent such decline. Detecting subclinical AF in home-bound, frail older adults may prompt evidence-based interventions (i.e. stroke prevention) that reduce the severe morbidity associated with AF. These investigations will contribute towards an expanded study to examine the prevalence of subclinical AF in a larger cohort of home-bound older adults and determine its prospective relation to adverse outcomes. Key mentoring in geriatric research and AF and integration in the Boston Claude Pepper Older Americans Independence Center will enhance the proposed investigations. 9/27/2012