The purpose of this research is to support the development of Dr. Abdulla Damluji into an independent investigator focused on studying geriatric syndromes during cardiovascular intervention. The K23 award will allow the development of a fundamental skillset including: the design and methods for analysis of interventions, understanding and proper application of frailty and resiliency assessments, designing pilot prospective studies, and enhancing knowledge of geriatrics and gerontology. Skills will be obtained through coursework, workshops, seminars, scientific meetings and mentored research. The overall goals are: 1) identify a simple universal bedside frailty test for clinical decision-making and 2) become an NIH-investigator prepared to conduct a clinical trial aimed to evaluate the comparative effectiveness of different treatments of acute myocardial infarction (AMI) in a heterogenous population of older adults living with frailty and lack of resiliency. Two thirds of all patients with cardiovascular disease (CVD) are older than 60 years of age, and >85% of patients over age 85 years live with some form of CVD. Of those older patients admitted with acute AMI, a majority experience frailty, a syndrome of decreased physiologic reserve and vulnerability to stressors. Moreover, some of these frail patients lack physical resiliency, the ability to rebound back and recover from a major health crisis. Critical ?gaps in knowledge? in cardiovascular care for older adults, particularly those with frailty and lack of resiliency, have been identified. These ?gaps? need to be addressed in order to provide the best possible care to a growing older patient population. This proposal examines the hypothesis that frailty and resiliency influence the treatment choice and health outcome after AMI.
Aim1 evaluates the prevalence of frailty in U.S. among older AMI patients by treatment [percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, or guideline-directed medical therapy (GDMT)] using the validated claims-based frailty index.
Aim 2 examines the role of frailty in treatment response to PCI and CABG.
Aim 3 validates the diagnostic accuracy of a bedside 4-item frailty scale and assesses whether this diagnostic tool, used in combination with resiliency measurements, can predict health outcomes at 1-year follow-up. The institutional environments at both the Inova Heart and Vascular Institute (IHVI) and Johns Hopkins University (JHU) are ideal for conducting cardiovascular outcomes research. The mentorship consists of leaders with expertise directly relevant to the career goals of the applicant: Christopher M O?Connor, MD (IHVI; expert in experimental design); Dr Wayne Batchelor (IHVI: interventional cardiologist); Jodi B Segal, MD, MPH (JHU: internist/epidemiologist; expertise in clinical effectiveness), and Gary Gerstenblith (JHU: geriatric cardiology). Resources at IHVI include bioinformatics laboratory, grant management office, and a state-of-the-art research office. At JHU, resources include the Bloomberg School of Public Health, Graduate Training Program in Clinical Investigation, JHU Pepper Center Biostatistical and Research Education Cores, and the Welch Medical Library.
More than two-thirds of older adults are living with symptomatic cardiovascular disease. Many live with undiagnosed geriatric syndromes including phenotypic frailty and lack of physical resilience. This research proposal will enhance our understanding of the influence of geriatric syndromes on health outcomes, disability, and health-related quality of life among older adults with acute myocardial infarction.