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.
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