Showing 7 ideas for tag "stroke"

Goal 2: Reduce Human Disease

Need to assess a new method of warfarin management vs. new oral anticoagulants in patients with atrial fibrillation

The two obstacles to warfarin therapy (keeping the INR in range and the associated hassles of frequent lab visits) can be eliminated by INR self testing and online "virtual clinic" monitoring and management (as demonstrated in six small studies. Achieving an INR percent time in range of approximately 75% to 80% is associated with a 50% or lower rate of thromboembolism and major bleeding. The studies of new oral anticoagulants... 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

If the ease and convenience of INR self testing, when combined with online virtual clinic management, can double the safety and efficacy of warfarin therapy, this form of therapy will benefit millions of patients with atrial fibrillation world wide. By extrapolation, this mode of therapy may also benefit millions of patients at risk of venous thrombosis, myocardial infarction, and stroke.

Feasibility and challenges of addressing this CQ or CC

This issue would require a prospective randomized control trial in moderate to high risk patients with atrial fibrillation to compare warfarin managed with such a system vs treatment with one of the new oral anticoagulants. Additional issues could be addressed if the study also included a warfarin arm with traditional management and/or an arm that involved monitoring of the new agent. The projected impact of the new warfarin management method on a composite end point of stroke, systemic embolism, major bleed and death is large enough (30 to 60 fewer events per 1,000 patients per year) that the sample size would be much smaller than the trials used to evaluate the new agents vs warfarin in atrial fibrillation.

Name of idea submitter and other team members who worked on this idea Henry I. Bussey, Pharm.D.

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73 net votes
93 up votes
20 down votes
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Goal 2: Reduce Human Disease

Does lowering circulating lipoprotein(a) levels influence cardiovascular outcomes?

A comprehensive research strategy and plan is needed to determine the most efficient, safe, cost-effective and widely applicable strategy to decrease circulating levels of lipoprotein(a) and to determine whether lowering circulating lipoprotein(a) levels will reduce the risk of developing cardiovascular disease such as a heart attack or a stroke as well as the progression of atherosclerosis or aortic stenosis.

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

Details on the impact of addressing this CQ or CC

Approximately 20% of the population are characterized by elevated circulating levels of lipoprotein(a), regardless of age, gender or blood cholesterol levels. Estimates suggest that up to 90% of the variation in plasma lipoprotein(a) levels could be due to genetic factors, which makes lipoprotein(a) the most prevalent inherited risk factor for cardiovascular diseases (CVD). Large-scale genetic studies have shown that Lipoprotein(a) was the strongest genetic determinant of CVD such as atherosclerosis and aortic stenosis. Lipoprotein(a) is one of the strongest predictors of residual CVD risk and has been shown to improve CVD risk prediction in several population-based studies. Lipoprotein(a) is also one of the strongest known risk factors for spontaneous ischemic stroke in childhood.
A comprehensive research strategy aiming at identifying, evaluating interaction with other risk factors, treating and educating patients with elevated lipoprotein(a) levels would result in substantial reductions of health care costs in the US and around the globe by reducing the burden of CVD while simultaneously improving the quality of life of these patients.

Feasibility and challenges of addressing this CQ or CC

The list of pharmaceutical agents that reduce lipoprotein(a) levels is steadily increasing. There are approximately half a dozen strategies that have been shown to significantly and safely lower lipoprotein(a) levels. One of the challenges of this research strategy will be to determine which of these strategies represent the most efficient, safe, cost-effective and widely applicable approach to lower lipoprotein(a) levels and CVD outcomes.
Increasing awareness on lipoprotein(a) and CVD will also be of utmost importance for this effort as relatively few physicians perform lipoprotein(a) testing and even fewer patients are aware of their lipoprotein(a) level. The first sign of high lipoprotein(a) is often a heart attack or stroke. Our challenge will be to identify patients with high lipoprotein(a) that could be enrolled in trials of risk characterization and lipoprotein(a)-lowering.

Name of idea submitter and other team members who worked on this idea Sandra Revill Tremulis on behalf of the Lipoprotein(a) Foundation Scientific Advisory Board

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235 net votes
297 up votes
62 down votes
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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

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11 net votes
19 up votes
8 down votes
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Goal 3: Advance Translational Research

Preventing Stroke from Atrial Fibrillation

How can health systems develop and implement validated measurement and feedback tools to identify patients with atrial fibrillation, categorize their risk factors for stroke, capture reasons for non-treatment, and develop interventions customized to those reasons to substantially improve the proportion of patients receiving effective oral anticoagulant stroke prevention treatment?

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

Details on the impact of addressing this CQ or CC

Registries show that only about half of patients with atrial fibrillation and risk for stroke are taking oral anticoagulants. Given 4 million Americans with atrial fibrillation, half of whom (2 million) are not treated, with 5% stroke rate per year, 67% of which can be prevented, there are 67000 strokes occuring in this untreated population per year in the US. Assuming half of these could be treated if programs were develped that were proven effective, this would result in 33,000 strokes prevented per year.

Feasibility and challenges of addressing this CQ or CC

NIH funds are needed to address the complex set of health system, psychosocial, and health IT issues to answer this question. Atrial fibrillation is a common condition with patients presenting and being treated accross various parts of the health care system. Small programs have shown promise for the use of the electronic health record to systematically identify patients with atrial fibrillation, but health system leadership needs evidence of success and guidance before this will be possible on a broad scale. With evidence of feasibility and impact, performance measures may be developed that would substantially enhance adaptation.

Name of idea submitter and other team members who worked on this idea Chris Granger

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6 net votes
8 up votes
2 down votes
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Goal 1: Promote Human Health

Investigating Co-Morbidities in Women's Cardiovascular Health

There are important questions related to the cardiovascular health of women, and particularly to diagnostic and therapeutic challenges arising from the common existence of co-morbid conditions. The latter consideration, as well as the limitations of the budgets of individual institutes and centers at the NIH, suggest that it may be reasonable for the NHLBI to consider cross-NIH collaborations with I/Cs that have related... 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

Collaboration across I/Cs could encourage investigators or teams to explore new concepts underlying the etiology of common or rare cardiovascular diseases (CVD), including stroke, particularly those with gender-related differences. In addition, clinical research on these disorders would benefit from active consideration of the common co-morbidities seen in patients with CVD, especially as patients with these co-morbidities are often specifically excluded from clinical trials. Since the patients who will ultimately benefit from treatments developed will often suffer from multiple other disorders, the societal benefit would be substantial. While any single I/C could support such studies, collaborative funding would be likely to bring together new teams of investigators with novel ideas.

Feasibility and challenges of addressing this CQ or CC

We believe that there is likely to be a good response from investigators, both basic and clinical, to collaborative, multi-I/C RFAs. It might be of additional benefit to provide some funds specifically for teams that are newly collaborative in response to the RFAs, to encourage increased cross-field collaboration.

Name of idea submitter and other team members who worked on this idea Rose Marie Robertson for American Heart Association

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3 net votes
3 up votes
0 down votes
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Goal 2: Reduce Human Disease

Asymptomatic carotid artery disease

What is the most effective approach to asymptomatic carotid artery disease to reduce the burden of stroke?

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

Details on the impact of addressing this CQ or CC

­Develop improved understanding of factors associated with carotid plaque progression and the reliable identification of higher risk asymptomatic lesions. This will lead to improved selection of asymptomatic patients for carotid intervention, a critical area of controversy and a highly prevalent condition.

Name of idea submitter and other team members who worked on this idea Society for Vascular Surgery

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2 net votes
3 up votes
1 down votes
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Goal 2: Reduce Human Disease

Improving pre-hospital therapy of HLB disorders

There is compelling evidence that pre-hospital therapy of both stroke and MI can improve outcomes and yet, with the exception of aspirin for MI, almost no care is administered pre-hospital in the U.S. NHLBI has a major stake in improving pre-hospital care because there already are sufficient data to show that currently available interventions would improve outcomes if they could be administered in the prehospital setting.... 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

The mortality and disability from stroke could be substantially reduced. The early mortality of STEMI and late disability from heart failure could be substantially reduced.

Feasibility and challenges of addressing this CQ or CC

There are numerous challenges including:
• Obtaining informed consent for pre-hospital clinical trials
• Fragmentation of EMS services by locale
• Need to train EMS personnel
• CMS rules on reimbursement for ambulance services and novel drugs

NHLBI could use its convening power in partnership with other groups to integrate this effort.

Name of idea submitter and other team members who worked on this idea Barry Coller

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0 net votes
1 up votes
1 down votes
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