Impact of Comorbidity Dyads on Heart Failure Treatment in Older Persons


Principal Investigator: Jerry H Gurwitz
Abstract: DESCRIPTION (provided by applicant): Multimorbidity greatly increases the risk of hospitalization and mortality among older HF patients. Certain dyads of chronic medical conditions are particularly prevalent in HF patients and place these individuals at substantially greater risk of subsequent morbidity and mortality. Chronic lung disease and chronic kidney disease are especially common, and among Medicare beneficiaries hospitalized with HF, these conditions are among the comorbidities that confer the highest excess mortality risk. This application responds to RFA-AG-13-003 (Secondary Analyses of Comparative Effectiveness, Health Outcomes, and Costs in Persons with Multiple Chronic Conditions). An opportunity exists to study the effectiveness and safety of common treatments for patients with HF who fall into certain highly prevalent comorbidity dyad groups: HF-chronic lung disease and HF-chronic kidney disease. Under a grant from the National Heart, Lung, and Blood Institute (Management and Outcomes of Heart Failure 1RC1HL09939), we developed a rich, clinical data set to characterize contemporary practice patterns and examine rates of death and hospitalization in over 30,000 HF patients, with nearly 80% 65 years of age or older. In response to RFA-AG-13-003, our proposed study will take advantage of this existing data set to address pressing knowledge gaps about important HF subgroups and the effectiveness and safety of HF-related therapies in these high risk patients, with regard to hospitalization and death. To address these issues, our experienced research team will pursue the following specific aims: (1) to characterize two large, community-based cohorts of patients with important HF-chronic condition dyads: HF-chronic lung disease (n= >12,000) and HF-chronic kidney disease (n= ~16,000);(2) to assess the clinical effectiveness and safety associated with the use of beta-blocker therapy for patients in the HF-chronic lung disease dyad group;and (3) to assess the clinical effectiveness and safety associated with the use of ACE inhibitors/angiotensin II receptor blockers (ARBs) and aldosterone antagonists for patients in the HF-chronic kidney disease dyad group.
Funding Period: 2013-09-01 - 2015-05-31
more information: NIH RePORT

Detail Information

Research Grants30

  1. A Collaboration for Improving Outcomes of African Americans with Heart Failure
    Adrian Hernandez; Fiscal Year: 2013
  2. Comparative Effectiveness of Anti-diabetic Medication Alternatives for Veterans
    Steven D Pizer; Fiscal Year: 2013
    ..Using a unique national sample of veterans and instrumental variables analysis we will examine the causal relationship between prescribing patterns and risk-adjusted health outcomes. ..
  3. Associations among RAAS Inhibitors, Residual Kidney Function, and CV Events in PD
    Jenny I Shen; Fiscal Year: 2013
    ..Further, the size of the database will allow us to study relevant patient subgroups. ..
  4. Validating and Classifying VA Readmissions For Quality Assessment and Improvement
    Amy K Rosen; Fiscal Year: 2013
    ..Hospital-specific risk-adjusted rates of potentially preventable readmission rates will be re-estimated using the "reclassified PPRs" and compared with hospital-level risk-adjusted rates. ..
  5. Impacts of Cost Sharing and Echocardiography on Outpatient Care of Heart Failure
    ..The results of these analyses will provide relevant data for both clinical and policy decision-making for patients with CHF. ..
  6. SCHS, mitochondria, healthy aging and longevity
    Gino A Cortopassi; Fiscal Year: 2013
    ..abstract_text> ..
  7. Reasons for the Excess Mortality and Functional Decline in Older Adults with CKD
    ..The proposed study will determine geriatric-specific risk factors that will lead to patient-centered interventions to reduc risks for mortality and functional decline among older adults with CKD. ..
  8. Diabetes and Aging in a Multi-Ethnic Population
    Andrew John Karter; Fiscal Year: 2013
    ..abstract_text> ..
  9. Changes in Cardiovascular Care and Outcomes in Eight Years after Medicare Part D
    Stephen B Soumerai; Fiscal Year: 2013
    ..In particular, we will examine changes in adherence and CVD treatment intensity for Part D patients in or near the coverage gap, by therapeutic drug class and by brand versus generic status. ..
  10. Multi-morbidity in Heart Failure
    Veronique L Roger; Fiscal Year: 2013
    ..The proposed research is distinctly feasible as it capitalizes on the infrastructure of the Rochester Epidemiology Project (R01 AG034676) and builds on the research team's robust experience. ..
  11. COPD Treatment in Older Adults with Depression
    LINDA J SIMONI-WASTILA; Fiscal Year: 2013
    ..abstract_text> ..
  12. Discovery and Development of Therapeutic Genes for CHF
    H Kirk Hammond; Fiscal Year: 2013
    ..Four Cores will support the Program: Digital Imaging (Dr. Farquhar);Vector Production (Dr. Miyanohara);Translational Systems (Dr. Hammond) and Clinical &Administrative (Dr. Hammond). ..
  13. Effectiveness of Radiotherapy for Prostate Cancer
    JUSTIN BEKELMAN; Fiscal Year: 2013
    ..Thus, this proposal has strong clinical relevance. Through this award, I will leverage important new skills in advanced health services research methods to become an independent, grant-funded physician-scientist. ..
  14. Renal Morbidity Following Kidney Cancer Surgery
    JOHN THOMAS LEPPERT; Fiscal Year: 2013
    ..Comparing the effect of kidney cancer surgery on kidney function will help inform treatment decisions and provide opportunities to improve care and clinical outcomes for patients diagnosed with kidney cancer. ..
  15. Atrial Fibrillation in Sepsis: Patient Outcomes and Provider Practice Patterns
    Allan J Walkey; Fiscal Year: 2013
    ..In addition, the career development and training skills learned during the award will allow the candidate to build and expand upon the currently limited data sources available for the study of patients with sepsis. ..
  16. Effectiveness of Second Line Hypoglycemic Medications Among Veterans
    Christianne Roumie; Fiscal Year: 2013
    ..The research team is poised to conduct a rigorous study on the safety and clinical effectiveness of second line therapies for DM. ..
  17. Use and Comparative Effectiveness of Innovative Therapies for Hepatocellular Carc
    Hanna K Sanoff; Fiscal Year: 2013
    ..Sanoff with an uncommon combination of skills in CE research and clinical trials. With her clinical expertise in hepatocellular carcinoma, she would be a unique position to further the research agenda of this deadly disease. ..
  18. Impact of New Technologies on Chronic Heart Failure Outcomes and Costs in the VHA
    Peter W Groeneveld; Fiscal Year: 2013
    SEAN M O'BRIEN; Fiscal Year: 2013
    ..The importance of this question to be addressed by ISCHEMIA-CKD is the reason it was ranked by the Institute of Medicine among the top 100 US priorities for comparative effectiveness research. ..
    RICHARD MARK ALLMAN; Fiscal Year: 2013
    ..By identifying potentially modifiable causes for decline in mobility after age 75, we will be able to develop interventions designed to enhance participation and quality of life for the burgeoning number of adults entering late life. ..
  21. Coping Skills Training in Heart Failure: Outcomes and Mechanisms
    Andrew Sherwood; Fiscal Year: 2013