B-Blocker effect on a range of health outcomes in older adults with CAD and COPD

描述（由申请人提供）：通过这项分析性流行病学研究，我们开始调查一种疾病的治疗可能加重其他疾病或对其他健康结果产生不利影响的情况。尽管对大量患有多种并发健康状况的老年人有潜在的危害，但这一主题很少受到研究关注。我们探讨了使用大型全国人口为基础的队列和新的分析技术，比较不同的干预策略的好处和危害，在一系列的健康结果领域，在复杂的老年人与多种发病率的能力。 为了制定我们的策略，我们开始研究β受体阻滞剂（2-受体阻滞剂）在合并冠心病（CAD）和慢性阻塞性肺疾病（COPD）患者中的强度。一旦我们用这个重要的临床问题测试了这个方法，我们将扩展到其他条件和药物。该项目建立在我们正在进行的多发病研究的基础上，包括将疾病特异性结果映射到全民健康结果，确定竞争条件之间的权衡，以及确定多种并发条件对死亡和其他健康结果的贡献。 我们的方法学目标是开发一种创新方法，用于在一种疾病的治疗可能加剧其他疾病或影响其他健康结果的情况下比较不同的治疗策略。使用我们的新方法，我们将检验以下假设：在患有CAD和COPD的可比老年人中，与无或较低2-阻滞剂强度相比，较大的2-阻滞剂强度与更少的CV事件和更低的死亡率相关，但与更频繁的不良肺部结局相关;呼吸困难、疲劳和活动水平更差，残疾更大。在次要分析中，我们将在根据年龄、CAD和COPD严重程度、性别、种族和合并症负担定义的相关亚组中探索这些目标。 将研究两个全国性的基于人口的队列，医疗保险当前受益人调查和医疗支出小组调查（研究样本35，000 - 40，000）。两者都有丰富的纵向参与者报告，药物和索赔/医疗保健利用数据。这种数据的深度和广度使我们能够使用创新的分析技术来评估治疗对疾病特异性和普遍健康结果（例如残疾，症状负担，功能限制和死亡）的影响，解释接受治疗的倾向和其他混杂因素。我们提出了一个新的模式，量化的危害和好处的治疗复杂的老年人多种条件。我们的最终目标是开发一种方法，用于确定具有多种疾病的老年人的最佳治疗方法，该方法可在每个患者的最高优先级结果域中最大限度地提高收益并最大限度地减少危害。 公共卫生相关性：在患有多种慢性病的人中，对一种疾病的治疗可能会加剧并发疾病或对总体健康结果产生不利影响。我们正在探索β受体阻滞剂在老年人中的使用是否有利于合并冠状动脉疾病（CAD）和慢性阻塞性肺疾病的心脏结局，但恶化肺部结局，症状或活动水平。研究结果可以帮助确定在越来越多的患有多种健康状况的老年人中，通常推荐的治疗方法的净效益或危害。

DESCRIPTION (provided by applicant): With this analytic epidemiologic study, we begin investigating situations in which the treatment of one condition may exacerbate other conditions or adversely affect other health outcomes. Despite potential harms to the large number of older individuals with multiple co-occurring health conditions, this topic has received little research attention. We explore the capability of using large national population-based cohorts and novel analytical techniques to compare the benefits and harms of different intervention strategies, across a range of health outcome domains, in complex older adults with multi-morbidity. To develop our strategy, we begin by investigating Beta-Blocker (2-Blocker) intensity in persons with co-occurring coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD). Once we have tested the method with this important clinical question, we will extent to other sets of conditions and medications. This project builds on our ongoing research on multi-morbidity that includes mapping disease-specific outcomes onto universal health outcomes, determining tradeoffs among competing conditions, and ascertaining the contribution of multiple co-occurring conditions to death and other health outcomes. Our methodological aim is to develop an innovative method for comparing different treatment strategies in situations in which the treatment of one condition could exacerbate other conditions or affect other health outcomes. Using our novel methods, we will test the hypothesis that, among comparable older adults with co- occurring CAD and COPD, greater 2-Blocker intensity is associated with fewer CV events and lower mortality but more frequent adverse pulmonary outcomes; worse dyspnea, fatigue, and activity levels and greater disability than no or lower 2-Blocker intensity. In secondary analyses, we will explore these aims in relevant subgroups defined by age, CAD and COPD severity, gender, race, and co-morbidity burden. Two national, population-based cohorts, the Medicare Current Beneficiary Survey and the Medical Expenditure Panel Survey will be studied (study sample 35,000-40,000). Both have a wealth of longitudinal participant-reported, medication, and claims/health care utilization data. This depth and breadth of data allows us to use innovative analytical techniques to assess the effects of treatments on disease-specific and universal health outcomes (e.g. disability, symptoms burden, functional limitations, and death), accounting for propensity to receive the treatment, and other confounders. We propose a new paradigm for quantifying the harms and benefits of treatments in complex older persons with multiple conditions. Our ultimate goal is to develop a method for determining the optimal treatments for older adults with multiple conditions that maximizes benefits and minimizes harms within the outcome domain(s) of highest priority for each patient. PUBLIC HEALTH RELEVANCE: Among persons with multiple chronic diseases, treatments for one disease may exacerbate co-occurring diseases or adversely affect overall health outcomes. We are exploring whether Beta-Blocker use in older adults with co-occurring coronary artery disease (CAD) and chronic obstructive pulmonary disease benefits cardiac outcomes but worsen pulmonary outcomes, symptoms, or activity levels. Study results can help determine the net benefit or harm of commonly recommended treatments among the growing number of older adults with multiple health conditions.