Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients

项目摘要/摘要 心力衰竭(HF)是老年人住院的最常见原因。超过85%的患者 因心力衰竭住院的患者年龄在65岁或以上。多发性疾病，通常定义为≥2的存在 慢性疾病增加了老年心力衰竭患者住院和死亡的风险，并极大地 使心力衰竭的临床治疗复杂化。在应用国家临床实践指南时需要谨慎 用于护理患有多发病的老年人，因为这可能导致不良的净影响， 最佳结果，包括药物与各种伴随疾病之间的不良相互作用。在……里面 对PA-17-088的响应(对现有队列、数据集和存储的生物样本进行探索性分析，以 解决临床老龄化研究问题，R01)，我们建议利用现有的HF队列，包括 2005-2012年间心血管研究网络中超过10万名心力衰竭患者的数据， 以及截至2017年的跟踪数据。我们将通过检查治疗模式和网络来扩展我们之前的努力 选择治疗方案对患有多种多发病的老年心力衰竭患者的利弊比较 负担。我们将进一步研究各种疗法的益处和不良后果，重点是 患有两种流行疾病--贫血或糖尿病--的心力衰竭患者中特别脆弱的亚群。 我们的具体目标是：(1)检查选定的药物疗法(肾素-血管紧张素- 醛固酮系统阻滞剂、β-阻滞剂、利尿剂和醛固酮受体阻滞剂)治疗死亡、心力衰竭 大量社区老年心力衰竭患者的住院治疗和各种原因的住院治疗 不同水平的多发病负荷和左心室射血分数；(2)评估有针对性的 不良后果，包括肾功能障碍、高钾血症、钠代谢紊乱、心动过缓和 老年心力衰竭患者中与所选心力衰竭治疗相关的晕厥，按多病负担和 左心室射血分数状态；和(3)描述潜在的益处和不良后果 在患有心力衰竭和两种流行的共病二联症的老年人中，与选定的心力衰竭疗法有关-心力衰竭- 糖尿病和心力衰竭--贫血--很常见，大大增加了死亡和发病率的风险。在……里面 此外，我们将创建新的、经过验证的方法来确定与HF治疗相关的不良结果 通过自然语言处理技术在大型电子健康记录系统中存储非结构化数据， 同时使用最先进的分析方法来评估与治疗相关的结果。因为我们的 拟议的调查将利用一大批地理和人口结构不同的 患有心力衰竭的成年人在社区医疗保健服务系统中接受护理，我们预期我们的发现 将非常普遍地适用于在“真实世界”实践中管理的心力衰竭的老年人 设置。

PROJECT SUMMARY/ABSTRACT Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, typically defined as the presence of ≥2 chronic conditions, increases the risks of hospitalization and death in older HF patients, and greatly complicates the clinical management of HF. Caution is required in applying national clinical practice guidelines to the care of older adults with multimorbidity, as this could result in undesirable net effects and less than optimal outcomes including adverse interactions between drugs and various concomitant diseases. In response to PA-17-088 (Exploratory Analyses of Existing Cohorts, Data Sets, and Stored Biospecimens to Address Clinical Aging Research Questions, R01), we propose to leverage an existing HF cohort, including data for more than 100,000 patients with HF within the Cardiovascular Research Network between 2005-2012, with follow-up data up to 2017. We will extend our previous efforts by examining treatment patterns and the net benefits versus harms of selected therapies in older adults with HF and a wide spectrum of multimorbidity burden. We will further examine the benefits and adverse outcomes of various therapies focusing on particularly vulnerable subgroups of patients with HF afflicted by two prevalent conditions, anemia or diabetes. Our specific aims are: (1) to examine the effectiveness of selected medical therapies (renin-angiotensin- aldosterone system blockers, beta-blockers, diuretics, and aldosterone receptor blockers) on death, HF hospitalization, and all-cause hospitalizations in a large, community-based population of older adults with HF across a range of levels of multimorbidity burden and left ventricular ejection fraction; (2) to evaluate targeted adverse outcomes, including kidney dysfunction, hyperkalemia, sodium disturbances, bradycardia, and syncope associated with selected HF therapies in older adults with HF, stratified by multimorbidity burden and left ventricular ejection fraction status; and (3) to characterize the potential benefits and adverse outcomes associated with selected HF therapies in older adults with HF and two prevalent comorbidity dyads—HF- diabetes and HF-anemia—that are common and substantially increase the risks of death and morbidity. In addition, we will create novel, validated methods to identify adverse outcomes related to HF therapies from unstructured data in large electronic health record systems through natural language processing technology, along with employing state-of-the-art analytic approaches to evaluate treatment-related outcomes. In that our proposed investigation will take advantage of a large, geographically and demographically diverse cohort of adults with HF receiving care within community-based healthcare delivery systems, we anticipate our findings will be highly generalizable to the broad spectrum of older adults with HF managed in “real-world” practice settings.