Heart failure (HF) is the number one cause of hospitalization among persons aged 65 years or older;yet our medical system has been slow to develop strategies to optimize the care of older patients with HF. The traditional disease-oriented model, which underlies most HF research and clinical care, focuses on individual diseases. This model fails to consider the broad spectrum of comorbidity, which includes impairments (in physical capacity, cognition, vision, hearing and psychological status) that often burden older patients with HF. These impairments may impede the ability of older patients to manage their illness, yet comorbid impairments remain largely invisible within the HF literature and quality indicators. Over the course of this 5-year award, Dr. Chaudhry will conduct two projects to enhance the scientific knowledge base about how comorbid impairments and diseases affect the functional outcomes of older patients with HF. In the first project, she will analyze data from the Cardiovascular Health Study (which now has over 10 years of follow-up) to compare the long-term functional outcomes of older persons with and without HF, and determine the relative contributions of comorbid impairments and diseases to the onset of functional disability. In the second project, she will conduct a prospective study to characterize the burden of comorbid impairments and diseases in older patients at the time of HF hospitalization and evaluate the relationship of these comorbidities to functional decline after hospital discharge. To enhance her career development, Dr. Chaudhry will complete formal coursework in chronic disease epidemiology, longitudinal data analysis, and data management. These activities, combined with the guidance of mentors from the Yale Program on Aging/Pepper Center and Robert Wood Johnson Clinical Scholars Program, will enable Dr. Chaudhry to establish an independent research program to improve the care of older patients with HF.

Public Health Relevance

Despite the billions of dollars spent each year caring for older patients with HF, outcomes have not improved in this population over the past decade. The results of the proposed research have the potential to fundamentally change our understanding of HF from an isolated disease to a true cardiogeriatric syndrome. Ultimately, these results will help to guide the development of more """"""""gerocentric"""""""" HF care based on routine management of co-morbid impairments, and to inform the next generation of HF quality indicators.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG030986-02
Application #
7666701
Study Section
Special Emphasis Panel (ZAG1-ZIJ-4 (M1))
Program Officer
Eldadah, Basil A
Project Start
2008-08-01
Project End
2013-05-31
Budget Start
2009-06-01
Budget End
2010-05-31
Support Year
2
Fiscal Year
2009
Total Cost
$141,777
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
Jayaram, Natalie M; Khariton, Yevgeniy; Krumholz, Harlan M et al. (2017) Impact of Telemonitoring on Health Status. Circ Cardiovasc Qual Outcomes 10:
Chaudhry, Sarwat I; Khan, Rabeea F; Chen, Jersey et al. (2014) National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc 3:e001197
Dodson, John A; Geda, Mary; Krumholz, Harlan M et al. (2014) Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study. BMC Health Serv Res 14:506
Chaudhry, Sarwat I; Murphy, Terrence E; Gahbauer, Evelyne et al. (2013) Restricting symptoms in the last year of life: a prospective cohort study. JAMA Intern Med 173:1534-40
Ning, Yuming; McAvay, Gail; Chaudhry, Sarwat I et al. (2013) Results differ by applying distinctive multiple imputation approaches on the longitudinal cardiovascular health study data. Exp Aging Res 39:27-43
Dodson, John A; Truong, Tuyet-Trinh N; Towle, Virginia R et al. (2013) Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes. Am J Med 126:120-6
Chaudhry, Sarwat I; McAvay, Gail; Chen, Shu et al. (2013) Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study. J Am Coll Cardiol 61:635-42
Dodson, John A; Chaudhry, Sarwat I (2013) The reply. Am J Med 126:e17
Dodson, John A; Chaudhry, Sarwat I (2012) Geriatric conditions in heart failure. Curr Cardiovasc Risk Rep 6:404-410
Ahluwalia, Sangeeta C; Gross, Cary P; Chaudhry, Sarwat I et al. (2012) Impact of comorbidity on mortality among older persons with advanced heart failure. J Gen Intern Med 27:513-9

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