Impact of Comorbidity Dyads on Heart Failure Treatment in Older Persons

描述（由申请人提供）：老年心衰患者的多重发病大大增加了住院和死亡的风险。慢性疾病的某些组合在心衰患者中尤为普遍，并使这些个体面临更大的发病率和死亡率风险。慢性肺部疾病和慢性肾脏疾病尤其常见，在因心衰住院的医疗保险受益人中，这些疾病是赋予最高超额死亡风险的合并症之一。本应用程序响应RFA-AG-13-003（多重慢性疾病患者的比较有效性、健康结果和成本的二次分析）。有机会研究常见治疗方法对HF患者的有效性和安全性，这些患者属于某些高度普遍的合并症组：HF-慢性肺部疾病和HF-慢性肾脏疾病。在国家心脏、肺和血液研究所（心力衰竭的管理和结果1RC1HL09939）的资助下，我们开发了丰富的临床数据集，以表征当代实践模式，并检查了30,000多名HF患者的死亡率和住院率，其中近80%的患者年龄在65岁或以上。为了响应RFA-AG-13-003，我们提出的研究将利用现有的数据集来解决关于重要HF亚组的紧迫知识空白，以及HF相关治疗在这些高风险患者中住院和死亡的有效性和安全性。为了解决这些问题，我们经验丰富的研究团队将追求以下具体目标：(1)描述两大基于社区的重要hf -慢性疾病患者队列：hf -慢性肺部疾病（n=约12,000）和hf -慢性肾脏疾病（n=约16,000）；(2)评估乙型受体阻滞剂治疗hf -慢性肺部疾病双组患者的临床有效性和安全性；(3)评估ACE抑制剂/血管紧张素II受体阻滞剂（ARBs）和醛固酮拮抗剂在hf -慢性肾病双组患者中的临床有效性和安全性。

DESCRIPTION (provided by applicant): Multimorbidity greatly increases the risk of hospitalization and mortality among older HF patients. Certain dyads of chronic medical conditions are particularly prevalent in HF patients and place these individuals at substantially greater risk of subsequent morbidity and mortality. Chronic lung disease and chronic kidney disease are especially common, and among Medicare beneficiaries hospitalized with HF, these conditions are among the comorbidities that confer the highest excess mortality risk. This application responds to RFA-AG-13-003 (Secondary Analyses of Comparative Effectiveness, Health Outcomes, and Costs in Persons with Multiple Chronic Conditions). An opportunity exists to study the effectiveness and safety of common treatments for patients with HF who fall into certain highly prevalent comorbidity dyad groups: HF-chronic lung disease and HF-chronic kidney disease. Under a grant from the National Heart, Lung, and Blood Institute (Management and Outcomes of Heart Failure 1RC1HL09939), we developed a rich, clinical data set to characterize contemporary practice patterns and examine rates of death and hospitalization in over 30,000 HF patients, with nearly 80% 65 years of age or older. In response to RFA-AG-13-003, our proposed study will take advantage of this existing data set to address pressing knowledge gaps about important HF subgroups and the effectiveness and safety of HF-related therapies in these high risk patients, with regard to hospitalization and death. To address these issues, our experienced research team will pursue the following specific aims: (1) to characterize two large, community-based cohorts of patients with important HF-chronic condition dyads: HF-chronic lung disease (n= >12,000) and HF-chronic kidney disease (n= ~16,000); (2) to assess the clinical effectiveness and safety associated with the use of beta-blocker therapy for patients in the HF-chronic lung disease dyad group; and (3) to assess the clinical effectiveness and safety associated with the use of ACE inhibitors/angiotensin II receptor blockers (ARBs) and aldosterone antagonists for patients in the HF-chronic kidney disease dyad group.