Understanding alcohol use and alcohol-related care among older adults with heart failure

项目摘要 老年人饮酒和滥用酒精的比例比其他任何年龄组都要快。 与此同时，心力衰竭（HF）的患病率，减少寿命和健康寿命的主要原因， 在老年人中，也在增加。酒精的使用和滥用可能会加剧和 加速HF，直接通过生物机制和间接通过阻碍参与的能力， 需要严格的自我管理，以避免不良的健康后果。如果是，解决饮酒问题， 在老年HF患者中误用有可能显著改善发病率、死亡率和质量 生活对于这个群体来说。然而，尽管有这些假设，人们对饮酒的影响知之甚少， 在老年HF患者中的滥用，也没有关于该人群接受的酒精相关护理。具体 本申请的目的是使用严格的因果推理和机器学习方法来1）估计 酒精使用和滥用与首次HF自我管理行为的关系; 2）产生 对酒精使用和滥用之间关系的偏差较小和更具普遍性的估计， 不良HF结局，目前对其了解甚少。此外，我们将3）描述数量 和来源（地点，提供者专业，患者-提供者关系的长度，提供者参与 负责任的护理组织）的记录酒精相关的护理目前接受的老年人， HF。为了实现这些目标，我们将利用两个现有数据源的链接： 健康和退休研究（HRS），一个全国代表性的纵向小组，22，000 + 老年人这项研究将由一个强大的酒精使用和滥用专家团队完成， 心血管疾病，人口老龄化，精神卫生保健协调，以及医疗保险分析 索赔和HRS。这项研究有可能为急需的循证指南提供信息， HF患者的临床管理以及未来的研究开发干预措施和政策， 改善这一人群中与酒精有关的护理和总体健康结果的提供。因此它 有助于推进NIAAA的战略目标，即确定和减少酒精对健康和疾病的影响 在整个生命周期中。它还直接响应NIAAA特别关注通知NOT-AA-20-018 “现有酒精研究数据的二次分析。

Project Summary Rates of alcohol use and misuse are increasing faster among older adults than among any other age group. Simultaneously, the prevalence of heart failure (HF), a major cause of reduced lifespan and health span among older adults, has also been increasing. It is possible that alcohol use and misuse exacerbate and accelerate HF, both directly via biological mechanisms and indirectly by hindering the ability to engage in the rigorous self-management required to avoid adverse health outcomes. If so, addressing alcohol use and misuse among older adults with HF has the potential to substantially improve morbidity, mortality, and quality of life for this population. Yet, despite these hypotheses, little is known about the effects of alcohol use and misuse among older adults with HF nor about the alcohol-related care received by this population. The specific aims of this application are to use rigorous causal inference and machine learning methods to 1) estimate the relationships of alcohol use and misuse with HF self-management behaviors for the first time and 2) produce less biased and more generalizable estimates of the relationships between alcohol use and misuse and adverse HF outcomes, which are currently poorly understood. In addition, we will 3) characterize the quantity and sources (venue, provider specialty, length of patient-provider relationship, provider participation in Accountable Care Organizations) of documented alcohol-related care currently received by older adults with HF. To accomplish these aims, we will utilize a linkage of two existing data sources: Medicare fee-for-service claims and the Health and Retirement Study (HRS), a nationally representative longitudinal panel of 22,000+ older adults. The research will be accomplished by a strong team of experts in alcohol use and misuse, cardiovascular conditions, aging populations, mental health care coordination, and analyses of Medicare claims and HRS. This research has the potential to inform critically needed evidence-based guidelines for clinical management of HF patients as well as future research developing interventions and policies that will improve the delivery of alcohol-related care and overall health outcomes among this population. As such, it helps advance NIAAA’s strategic goal of identifying and reducing alcohol’s influence on health and disease throughout the lifespan. It also responds directly to NIAAA Notice of Special Interest NOT-AA-20-018 “Secondary Analyses of Existing Alcohol Research Data.”