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.

Public Health Relevance

Our proposed study aligns well with the national imperative to improve the health status of persons with multiple chronic conditions (MCCs). Our efforts will serve to address key components of the Department of Health and Human Services strategic framework to improve the health status of individuals with MCCs by filling knowledge gaps that exist regarding the health and healthcare of these important groups of patients.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AG045320-02
Application #
8725571
Study Section
Special Emphasis Panel (ZAG1)
Program Officer
Salive, Marcel
Project Start
2013-09-01
Project End
2015-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Worcester
State
MA
Country
United States
Zip Code
01655
Gurwitz, Jerry H; Magid, David J; Smith, David H et al. (2017) Treatment Effectiveness in Heart Failure with Comorbidity: Lung Disease and Kidney Disease. J Am Geriatr Soc 65:2610-2618
Tisminetzky, Mayra; Goldberg, Robert; Gurwitz, Jerry H (2016) Magnitude and Impact of Multimorbidity on Clinical Outcomes in Older Adults with Cardiovascular Disease: A Literature Review. Clin Geriatr Med 32:227-46
Marcum, Zachary A; Hardy, Susan E (2015) Medication Management Skills in Older Skilled Nursing Facility Residents Transitioning Home. J Am Geriatr Soc 63:1266-8
Marcum, Zachary A; Gurwitz, Jerry H; Colón-Emeric, Cathleen et al. (2015) Pills and ills: methodological problems in pharmacological research. J Am Geriatr Soc 63:829-30