Re-thinking the Role of Stress Imaging for Symptomatic Older Adults with Stable Coronary Artery Disease

项目摘要/摘要 超过四分之一的75岁以上的成年人患有有症状的稳定性缺血性心脏病。压力 核成像是诊断和处理冠状动脉病变最常见的检查之一。 这些老年人的动脉疾病。老年人更有可能同时存在功能障碍， 认知和多发病，这可能限制他们从成像测试和测试后治疗中受益。 虽然压力测试经常被用来评估症状，但临床医生不太可能推荐老年人进行 即使压力测试结果严重异常，他们也可以进行血运重建或优化药物治疗。反过来, 这可能会导致过度使用检测、增加并发症和护理成本，而不会改善患者 结果。帮助出现可疑缺血症状的老年患者了解情况 决定，临床医生应该将成像的好处和成像后的治疗策略结合起来 引发护理目标的背景，临床 减损。理解这一点很重要 临床表现、心脏危险因素和潜在的年龄相关因素 如何改善老年人之间的共同决策并确定 有症状的稳定性缺血性心脏病老年人影像检查过度或使用不足的区域 疾病。 在这个项目中，我使用多方利益相关者的方法来理解患者在压力测试后的决策， 护理者和医生的观点，并研究其与有症状的老年人预后的关系 疑似或已知的冠心病患者。我的研究目的是(A)了解老年患者和照顾者的态度 关于成像后治疗选择与他们的首选结果和年龄相关损害的关系 通过焦点小组访谈和(B1)检查心血管疾病和老年风险之间的联系 成像后治疗选择的因素(即，侵入性转诊与医疗优化)；以及(B2)比较 接受成像后的治疗与患者的症状、功能和生活质量的关系 有症状的老年人75岁在我们的健康范围内接受临床指示的应激核素成像 系统。这项研究将有助于指导我未来旨在开发和测试个性化决策辅助工具的工作 指导有症状的老年冠心病患者的检查和治疗的选择。这个GEMSSTAR奖将 还为我提供所需的支持、指导和培训，使我成为 老年稳定型缺血性心脏病患者的心血管成像和共同决策。

PROJECT SUMMARY/ABSTRACT More than a quarter of all adults older than 75 years have symptomatic stable ischemic heart disease. Stress nuclear imaging is the one of the most common tests performed for diagnosis and management of coronary artery disease in these older adults. Older adults are more likely to have co-existing impairments in function, cognition and multimorbidity, which may limit their benefit from imaging tests and post-test treatment, alike. Although stress testing is often used to evaluate symptoms, clinicians are less likely to refer older adults for revascularization or to optimize their medical therapy, even if stress test results are severely abnormal. In turn, this can result in overuse of testing, increased complications and cost of care without improving patient outcomes. To help older patients presenting with suspected ischemic symptoms make a well-informed decision, clinicians should contextualize the benefits of imaging and treatment strategies post imaging in context of elicited goals of care, clinical impairments. It is critical to understand presentation, cardiac risk factors and potential age-related how to improve shared decision making among older adults and identify areas of imaging test overuse or underuse among older adults with symptomatic stable ischemic heart disease. In this project, I use a multi-stakeholder approach to understand post-stress test decision making from patient, caregiver and physician perspectives and study its association with outcomes among symptomatic older adults with suspected or known CAD. My research aims are to (a) understand older patient and caregiver attitudes about post-imaging treatment choice in context of their preferred outcomes and age-related impairments through focus group interviews and (b1) examine the association between cardiovascular and geriatric risk factors on post-imaging treatment choice (i.e., invasive referral vs. medical optimization); and (b2) compare the association of treatment received post-imaging and patients' symptoms, function and quality of life among symptomatic older adults  75 years undergoing clinically indicated stress nuclear imaging within our health system. This study will help inform my future work aimed at developing and testing personalized decision aids to guide choice of testing and treatment for symptomatic older adults with CAD. This GEMSSTAR award will also provide me with the support, mentorship and training required to become a leader in field of cardiovascular imaging and shared decision-making for older adults with stable ischemic heart disease.