Optimizing Outcomes for Patients with Heart Failure and Atrial Fibrillation

项目总结/摘要 心房颤动（AF）是成人中最常见的持续性心律失常，并且导致显著的发病率和死亡率。 mortality.在最严重的心力衰竭（HF）患者中，AF患病率高达50%， AF和HF患者的预后非常差。然而，房颤对HF患者的负担报告了结局 （PROs）没有很好的描述。此外，虽然房颤的导管消融术与总体改善相关， 然而，并非所有患者都能从消融术中获益。我的目标是寻求一个指导研究职业发展 获奖是为了获得必要的培训和经验，以发展独立的研究生涯为重点 改善心律失常患者的个性化治疗和结局。 在本提案中，我们将通过3项措施， 特定目的，包括：（1）比较合并和不合并AF的HF患者之间的PRO;（2） 描述接受AF消融术的AF和HF患者的临床病程;以及（3）识别 AF和HF最有可能从AF消融术中受益。 在犹他州，提出的目标将提供新的见解，共同发生的HF和AF的负担， 使用客观、结构化和系统化的经验证的PRO测量方法收集生活质量 在整个医疗系统中。 该职业发展计划将由国际知名的健康领域专家指导 服务研究、PRO、AF结局、HF治疗和AF消融：卫生部主任Rachel Hess博士 犹他州PRO项目的系统创新和研究及医学主任; James Fang和Josef博士 Stehlik，HF的思想领袖; Jonathan Piccini和Nassir Marrouche博士，电生理学家， AF消融的国际领导者; PRO研究的先驱John Spertus博士;以及Tom格林教授， 有经验的统计主任与正式教学法相结合，它们将提供所需的支持， 实现我的培训目标，发展技能：（1）使用和解释PRO;（2）分析 纵向结果;（3）使用多变量预测模型的治疗效果异质性。 总之，提出的科学目标的结果将有助于指导患者的治疗， 随着培训目标的完成，我将被定位为一个有创的，临床的， 心脏电生理学家，受过严格的观察研究方法的教育， PRO和治疗效果的异质性。职业发展补助金提案 将为我提供必要的技能，成功地追求我的目标，建立一个独立的 研究计划，旨在为心脏节律紊乱患者提供个性化治疗。

PROJECT SUMMARY/ABSTRACT Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and leads to significant morbidity and mortality. Among the sickest patients with heart failure (HF), AF prevalence is up to 50%, and the prognosis of patients with both AF and HF is very poor. However, the burden of AF on HF patient reported outcomes (PROs) is not well-described. Additionally, while catheter ablation for AF is associated with improved overall outcomes, not all patients benefit from ablation. My goal in seeking a Mentored Research Career Development Award is to acquire the necessary training and experience to develop an independent research career focused on improving personalization of treatment and outcomes for patients with heart rhythm disorders. In this proposal we will close knowledge gaps in the management of patients with HF and AF, through the 3 specific aims, which are to: (1) compare PROs between HF patients with and without co-existing AF; (2) describe the clinical course of patients with AF and HF undergoing AF ablation; and (3) identify patients with AF and HF most likely to benefit from ablation for AF. Leveraging resources unique to the University of Utah, the proposed aims will provide novel insights into the burden of co-occurring HF and AF on quality of life using objective, structured, and systematic collection of validated PROs measures across the healthcare system. This career development plan will be mentored by internationally-renowned experts in the fields of health services research, PROs, outcomes in AF, HF therapies, and AF ablation: Dr. Rachel Hess, Chief of Health System Innovation and Research and Medical Director of the Utah PRO program; Drs. James Fang and Josef Stehlik, thought-leaders in HF; Drs. Jonathan Piccini and Nassir Marrouche, electrophysiologists and international leaders in AF ablation; Dr. John Spertus, a pioneer in PRO research; and Professor Tom Greene, an experienced statistical director. Combined with formal didactics, they will provide the support needed to achieve my training aims, developing skills in: (1) the use and interpretation of PROs; (2) analyses of longitudinal outcomes; and (3) the use of multivariable predictive modeling of treatment effect heterogeneity. In summary, the results of the proposed scientific aims will help guide the treatment of patients with HF and AF. With completion of the training aims, I will be uniquely-positioned as an invasive, clinical, cardiac electrophysiologist, educated in rigorous observational research methods with an emphasis on PROs and heterogeneity of treatment effects. The proposed Career Development Grant proposal will provide me the necessary skills to successfully pursue my goal of establishing an independent research program geared towards personalizing treatments for patients with heart rhythm disorders.