While it is clearly established that elevated total and low density lipoprotein cholesterol predict future cardiac events in younger patients, there is lack of consistent data regarding the prognostic value of these lipoproteins in elderly (age >75) patients with CAD. Further, while lipid lowering therapy is associated with significant clinical benefits in patients less than 75 years with MI, no randomized clinical trial has assessed their efficacy in the older (>75) patient with MI. Finally, older patients? knowledge, beliefs and preferences regarding prevention have not been elucidated. The proposed project seeks specifically to broaden our understanding of the prognostic role of cholesterol n the elderly, provide insight into the effectiveness of lipid lowering, and determine domains of 0 der patients? preferences regarding lipid lowering and preventive care. This is a research plan with four specific aims.
Aims 1, 2, and 3 address critical gaps in knowledge surrounding lipids n the elderly utilizing an innovative collaboration between academia and the National AMI project, a quality improvement initiative sponsored by HCFA. This project, organized and implemented by the current investigators, contains medical record abstraction for over 250,000 Medicare beneficiaries hospitalized with MI in the U.S. in 1994-1995 and 1998-1999. The investigators seek to use data and enrich them to create research database capable of producing knowledge about lipid lowering therapy and future efforts to improve I the care and outcomes of older persons with MI.
Aim 4 extends research into patient preferences in the elderly, l a generally unexamined area. This phase will use qualitative methodology to ascertain older patients? preferences regarding preventive treatment, treatment goals and quality of life, and to develop a taxonomy for elderly patients? primary prevention treatment preferences. Capitalizing on institutional strengths in outcomes research, geriatrics, and cardiology, the proposed research builds on prior work to form the basis for a sustained career in prevention in the elderly. The applicant will gain experience and insight to conduct independent health services research aimed at improving quality of care and clinical outcomes for older people with cardiovascular disease. This work will ultimately improve care for the elderly patient with cardiovascular disease.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08AG020623-02
Application #
6653817
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Premen, Andre J
Project Start
2002-09-15
Project End
2006-08-31
Budget Start
2003-09-01
Budget End
2004-08-31
Support Year
2
Fiscal Year
2003
Total Cost
$124,875
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Rathore, Saif S; Curtis, Jeptha P; Nallamothu, Brahmajee K et al. (2009) Association of door-to-balloon time and mortality in patients > or =65 years with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 104:1198-203
Tinetti, Mary E; McAvay, Gail J; Fried, Terri R et al. (2008) Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes. J Am Geriatr Soc 56:1409-16
Tinetti, Mary E; McAvay, Gail J; Fried, Terri R et al. (2008) Development of a tool for eliciting patient priority from among competing cardiovascular disease, medication-symptoms, and fall injury outcomes. J Am Geriatr Soc 56:730-6
Agostini, Joseph V; Tinetti, Mary E; Han, Ling et al. (2007) Association between antihypertensive medication use and non-cardiovascular outcomes in older men. J Gen Intern Med 22:1661-7
Shah, Rahman; Selter, Jared; Wang, Yun et al. (2007) Association of troponin status with guideline-based management of acute myocardial infarction in older persons. Arch Intern Med 167:1621-8
Agostini, Joseph V; Tinetti, Mary E; Han, Ling et al. (2007) Effects of statin use on muscle strength, cognition, and depressive symptoms in older adults. J Am Geriatr Soc 55:420-5
Shah, Rahman; Wang, Yun; Masoudi, Frederick A et al. (2007) Sex and racial differences in outcomes and guideline-based management of troponin-only-positive acute myocardial infarction in older persons. Am J Geriatr Cardiol 16:97-105
Foody, JoAnne Micale; Rathore, Saif S; Galusha, Deron et al. (2006) Hydroxymethylglutaryl-CoA reductase inhibitors in older persons with acute myocardial infarction: evidence for an age-statin interaction. J Am Geriatr Soc 54:421-30
Rathore, Saif S; Masoudi, Frederick A; Wang, Yongfei et al. (2006) Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project. Am Heart J 152:371-8
Kapoor, John R; Chaudry, Sarwat; Agostini, Joseph V et al. (2006) Systolic hypertension in older persons: how aggressive should treatment be? Prog Cardiovasc Dis 48:397-406

Showing the most recent 10 out of 25 publications