Comorbidity and Functional Outcomes in Older Patients with Heart Failure

项目总结：心力衰竭（HF）是老年人住院的头号原因， 65岁或以上;然而，我们的医疗系统在制定优化老年人护理的战略方面进展缓慢 HF患者。传统的以疾病为导向的模式是大多数HF研究和临床护理的基础， 关注个别疾病。这种模式没有考虑到广泛的合并症， 包括（体能、认知、视力、听力和心理状态）的损伤， 加重老年HF患者的负担。这些损伤可能会阻碍老年患者管理其 然而，在HF文献和质量指标中，共病损害在很大程度上仍然不可见。 在这个为期5年的奖项，乔杜里博士将进行两个项目，以提高科学 关于共病损伤和疾病如何影响老年人功能结果的知识库 HF患者。在第一个项目中，她将分析来自心血管健康研究（现在 有超过10年的随访），以比较老年人的长期功能结果， 无HF，并确定共病损害和疾病对HF发作的相对贡献。 功能性残疾在第二个项目中，她将进行一项前瞻性研究， 老年患者在HF住院时的共病损害和疾病，并评估 这些合并症与出院后功能下降的关系。为了提升她的事业 发展，乔杜里博士将完成正式的课程在慢性病流行病学，纵向 数据分析和数据管理。这些活动，结合耶鲁大学导师的指导， 老龄化/胡椒中心和罗伯特伍德约翰逊临床学者计划，将使博士。 Chaudhry建立一个独立的研究项目，以改善老年HF患者的护理。 相关性：尽管每年花费数十亿美元治疗老年HF患者， 在过去的十年里，这一人群的情况没有改善。拟议研究的结果具有 有可能从根本上改变我们对HF的理解，从一种孤立的疾病转变为真正的老年心脏病 综合征最终，这些结果将有助于指导更多的“以老年人为中心”的HF护理的发展。 共病损害的常规管理，并告知下一代HF质量指标。

PROJECT SUMMARY: Heart failure (HF) is the number one cause of hospitalization among persons aged 65 years or older; yet our medical system has been slow to develop strategies to optimize the care of older patients with HF. The traditional disease-oriented model, which underlies most HF research and clinical care, focuses on individual diseases. This model fails to consider the broad spectrum of comorbidity, which includes impairments (in physical capacity, cognition, vision, hearing and psychological status) that often burden older patients with HF. These impairments may impede the ability of older patients to manage their illness, yet comorbid impairments remain largely invisible within the HF literature and quality indicators. Over the course of this 5-year award, Dr. Chaudhry will conduct two projects to enhance the scientific knowledge base about how comorbid impairments and diseases affect the functional outcomes of older patients with HF. In the first project, she will analyze data from the Cardiovascular Health Study (which now has over 10 years of follow-up) to compare the long-term functional outcomes of older persons with and without HF, and determine the relative contributions of comorbid impairments and diseases to the onset of functional disability. In the second project, she will conduct a prospective study to characterize the burden of comorbid impairments and diseases in older patients at the time of HF hospitalization and evaluate the relationship of these comorbidities to functional decline after hospital discharge. To enhance her career development, Dr. Chaudhry will complete formal coursework in chronic disease epidemiology, longitudinal data analysis, and data management. These activities, combined with the guidance of mentors from the Yale Program on Aging/Pepper Center and Robert Wood Johnson Clinical Scholars Program, will enable Dr. Chaudhry to establish an independent research program to improve the care of older patients with HF. RELEVANCE: Despite the billions of dollars spent each year caring for older patients with HF, outcomes have not improved in this population over the past decade. The results of the proposed research have the potential to fundamentally change our understanding of HF from an isolated disease to a true cardiogeriatric syndrome. Ultimately, these results will help to guide the development of more "gerocentric" HF care based on routine management of comorbid impairments, and to inform the next generation of HF quality indicators.