Transcultural lessons in the Management of Heart Failure TRANSMEDHF

项目摘要 在美国（USA）和英国（UK），心力衰竭（HF）是常见的 住院原因，往往延长住院时间，并与高死亡率有关。虽然 HF管理的国际指南是一致的，实践在不同国家有很大差异。 国家潜在的因素有很多，如医疗保健资金的可变性，民族和种族多样性 其中包括可能导致实践模式变化的因素，但尚不清楚这是否会转化为 结果的差异。因此，我们建议使用以下方法评估和比较患者的结局： 个体患者水平数据（IPLD），在美国和美国有不同程度的心力衰竭（HF）证据。 英国.比较整个人群的汇总高水平数据可能会导致错误的结论。获得 个体患者水平数据（IPLD）使这两个国家具有相似属性的患者的结果能够 并以统一的方式进行分析。由于HF的定义并不稳健， 在美国和英国可能有很大的不同，案件认定的广泛标准将被应用于捕捉 感兴趣的人群。这将包括HF的诊断和袢利尿剂的处方， 同时或既往诊断为HF（服用袢利尿剂的患者预后较差，通常可能 反映HF的漏诊）。 植入式心律转复除颤器（ICD）/心脏再同步治疗的支出 (CRT)/起搏器和除颤器估计为c.$ 5.8 2009年在美国的亿。然而， 的ICD和CRT仅在选择用于临床试验的患者中建立， 发病率;老年人和少数民族代表不足。因此，试验结果的外部有效性 还不清楚比较接受ICD和CRT的“真实的世界”患者的实践模式和临床结局 在不同的卫生系统中，不同的做法可能有助于改善患者的选择， 两国的管理。也有人怀疑CRT-D与CRT-P相比的优越性， 是一种不太昂贵的技术，需要不太复杂的后续操作，并且也不太可能发生故障。这 将导致对这两个系统的更深入的理解，并可作为医疗保健的投入 政策措施 这个雄心勃勃的真实的世界项目将在三个领先的学术研究中心进行- 克利夫兰医学中心/凯斯西储大学（克利夫兰，俄亥俄州，美国）， 国家心肺研究所/帝国理工学院（英国伦敦）和罗伯逊生物统计中心 /格拉斯哥大学（联合王国苏格兰）。

PROJECT ABSTRACT In both the United States of America (USA) and the United Kingdom (UK), heart failure (HF) is a common cause of hospitalization, often prolongs length of hospitalization and is associated with high mortality. Although international guidelines on the management of HF are aligned, practice is substantially divergent across countries. There are potentially myriad factors such as variability in healthcare funding, ethnic and racial diversity among others that could be contributing to the variation in practice patterns but it is unclear if this translates into differences in outcomes. We, therefore, propose to evaluate and compare the outcome of patients, using individual patient –level data (IPLD), with varying levels of evidence for heart failure (HF) in the USA and in the UK. Comparing aggregate high level data for whole population could lead to erroneous conclusions. Access to individual patient-level data (IPLD) enables the outcome of patients with similar attributes in the two countries to be juxtaposed and be analyzed in a uniform manner. As definitions of HF are not robust and diagnostic incentives may differ substantially in the USA and UK, broad criteria for case-ascertainment will be applied to capture the population of interest. This will include both a diagnosis of HF and a prescription of a loop diuretic with a concurrent or previous diagnosis of HF (patients taking loop diuretics have a poor prognosis which may often reflect a missed diagnosis of HF). Spending on Implantable Cardioverter Defibrillator (ICD)/Cardiac Resynchronization Therapy (CRT)/Pacemakers and defibrillators estimated to be c.$5.8 billion in the USA in 2009. However, the efficacies of ICDs and CRTs have been established only in patients selected for clinical trials with relatively few co- morbidities; older people and ethnic minorities were under-represented. Thus, the external validity of trial results is unclear. Comparing practice patterns and clinical outcomes in `real world' patients receiving ICD and CRT across different health systems with widely differing practice might help improve patient selection and management in both countries. There are also doubts about the superiority of CRT-D compared to CRT-P, which is a less expensive technology requiring less sophisticated follow up and is also less likely to malfunction. This would lead to a much more in depth understanding of the two systems and could serve as an input for healthcare policy measures. This ambitious real world project will be conducted in three leading academic research centers – University Hospitals Cleveland Medical Center/Case Western Reserve University (Cleveland, Ohio, USA), National Heart and Lung Institute/Imperial College (London, England, UK) and Robertson Center for Biostatistics /University of Glasgow (Scotland, UK).