Showing 4 ideas for tag "elderly"

Goal 2: Reduce Human Disease

Understanding Cardiothoracic Surgery in Elderly Populations

There is a vital need for evidence-based clinical evaluation tools to assess operative risk and post-operative recovery in the elderly, including biomarkers of physiologic age and a simple/reliable clinical evaluation scheme to determine frailty as a risk factor for poor surgical outcomes.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Development of tools to assess operative risk and post-operative recover in the elderly would improve surgical outcomes in this growing patient population.

Feasibility and challenges of addressing this CQ or CC

This at risk population is growing rapidly.
Older patients represent an important, different, and under-studied subgroup of those undergoing cardiothoracic surgery according to the Joint NHLBI-AATS Working Group (http://aats.org/CME/2011-AATS-NHLBI-Symposium.cgi). Due to the aging of the US population and the increased severity of coronary and valve disease in older individuals, the use of cardiothoracic surgery in older patients in relative terms is growing rapidly. Between 1990 and 2008, the percentage of those aged 80 years or older has gone from 8% to 16% of total for bypass surgery and 14% to 30% of total for valve surgery.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

Voting

39 net votes
56 up votes
17 down votes
Active

Goal 2: Reduce Human Disease

Transplant to Cure Older Adults with Hematologic Malignancy-Removing the Blindfold

While transplant for patients 60 and older for high-risk hematologic malignancies has increased and observational data are promising, the risks and benefits of translant versus non-transplant remain largely unknown. We now have the tools and mechanisms to remove the blindfold!

The NHLBI should support the cooperative groups in conjunction with the BMT-CTN to establish a common framework for transplant trials in older... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Hematologic malignancies are more common and less treatable in older patients. This trend will contine as the number and proportion of older people in society increases. Older patients are frequently treated but rarely on studies. The availability of haploidentical and cord donor sources, better supportive care, and more tolerable regimens permits transplant to be widely accessible and utilized.

A critical question for the entire field of hematologic malignancies is determing the risks and benefits of allogeneic transplant for older adults. This question is posed across the country, every day by every patient and physician struggling to treat older adults with hematologic malignancies. The confluence of molecular and cytogenetic disease markers and novel measures of patient health should permit identifying those most likely to be cured and those least likely to benefit. Such data will ultimately inform the next generation of transplant trials in this population.

Feasibility and challenges of addressing this CQ or CC

The number of patients with any of these diseases (e.g., AML, MDS, NHL and perhaps ALL) who are 60 years and older is significant. The challenge is to develop a coordinated effort to prospectively capture disease and patient health data to answer which subgroups benefit or do not.
Methods to capture patient health status have already been developed through a standardized Geriatric Assessment used in the Alliance and other studies. Most of the survey can be done electronically by a patient or by telephone. Disease based molecular markers have emerged as standard measures within cooperative group studies to augment cytogenetic and morphologic classification.

Ensuring cooperative groups develop uniform design and data may be difficult. Yet investigators gain much and lose little by standardizing the data capture of what already occurs (patients moving to transplant on hematologic malignancy trials).

Another challenge is to develop standardized measures after transplant beyond survival such as function free survival and quality of life that are patient centered. Electronic tools to capture data, especially for non-transplant patients, will greatly reduce this burden.

Name of idea submitter and other team members who worked on this idea Andrew Artz

Voting

20 net votes
36 up votes
16 down votes
Active

Goal 2: Reduce Human Disease

Restoring Balance to Stroke Prevention in Older AFib Patients

Improving Tools for Anticoagulation Decision-Making

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

AFib increases stroke risk by five-fold and doubles the risk that a stroke will result in permanent disability. While oral anticoagulation (OAC) is highly effective at reducing stroke risk, elderly patients are often under-anticoagulated. This is in part due to an under-appreciation of the stroke risk associated with AFib and the tendency of some health care professionals to prioritize perceived bleeding risk over stroke prophylaxis. Because current bleeding risk assessment tools are imperfect and largely unable to predict patients who are likely to have bleeding complications, they are often not utilized—or if used, do not truly predict which patients are at risk of a bleed. An improved bleeding risk tool is critical to improved risk assessment in the elderly. That bleeding risk tool should then be combined with the stroke risk tool for single risk stratification to streamline anticoagulation decision-making.

Feasibility and challenges of addressing this CQ or CC

Developing effective integrated risk assessment tools is feasible only if there is consensus on the validity of the clinical information being provided. The approach to this critical challenge is two-fold. First, needed research that improves the reliability of bleeding risk assessment in the elderly should be pursued. Second, stroke and bleeding risk tools should be combined into a single risk stratification tool. This will require significant investment and focus, but the resulting bleeding risk assessment combined with the accepted CHA2DS2-VASc score, would significantly impact the 40 - 60% of patients who are currently not on an anticoagulant and are at increased risk of stroke and death.

Name of idea submitter and other team members who worked on this idea AFib Optimal Treatment Task Force

Voting

11 net votes
19 up votes
8 down votes
Active

Goal 2: Reduce Human Disease

Cardiac Defibrillator Therapy Management in the Elderly

Older patients have been largely under represented in the landmark clinical trials that have established the beneficial effects of ICD therapy on survival. With older age, comorbidities increase leading to a higher incidence of non-cardiac mortality. This is supported by very well documented decrease in the incidence of appropriate defibrillator shocks.
Based on the above, it is important to know whether defibrillator... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Given the increase in the proportion of older patients in the US, addressing these important questions regarding the value of defibrillator therapy in this stratum of the population is critical to:

  1. Avoid unnecessary surgeries with its complications (short term and long term)
  2. Reduce the cost of health care, primarily in a Medicare population
Feasibility and challenges of addressing this CQ or CC

A large multi-center non-inferiority trial of CRT-P vs. CRT-D ( and at alater stage of ICD vs. No ICD) in the elderly is needed to answer these questions. These trials are feasible but require comittment and resources.

Name of idea submitter and other team members who worked on this idea Samir Saba

Voting

4 net votes
16 up votes
12 down votes
Active