Patient-Centered Outcomes in Carotid Artery Stenosis
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Project Summary Abstract Older patients with carotid artery atherosclerotic disease are at risk of stroke, and some evidence suggests that people are affected by their carotid artery stenosis even in the absence of a stroke. These non-stroke outcomes are poorly studied, but may include cognitive decline, sleep disturbances, and mood abnormalities. Whether medication or surgery for carotid artery stenosis improves these non-stroke symptoms is unclear. Therefore, it is necessary to identify the best way to measure these non-stroke patient-reported outcomes to be able to study how carotid artery stenosis treatment affects these symptoms. A reliable and accurate measurement of patient-reported outcomes in carotid artery stenosis will enable identification and tracking of these symptoms throughout the treatment continuum. Research Aim 1 of this project will use instruments developed by the National Institutes of Health to measure quality-of-life and function across diseases, as well as a robust, multidimensional assessment of cognition (NIH Patient-Reported Outcomes Measurement Information System; NIH Toolbox-Cognitive Battery). These will be collected on people with a diagnosis of carotid artery stenosis, including those with prior medical or surgical treatment, and newly diagnosed carotid artery disease requiring surgery. Patients will have at least two timepoints 6 months apart, with more frequent assessments directly after surgery in patients undergoing surgery during this study period. Research Aim 2 of this project will use interviews and focus groups to gain patient and caregiver perspectives about non-stroke changes that may have occurred after revascularization for carotid artery stenosis. This data will help select the best measures of non-stroke outcomes for carotid artery stenosis to be used in large scale trials evaluating which treatment is best for which patients. For older patients with carotid artery disease, this research will ensure better alignment of treatment with the 4M Geriatric Framework of Age-Friendly Health Systems. With this lens, we will better understand how to align treatment of carotid artery stenosis with 1) what matters most to patients, 2) how medication treatment effects older patients, 3) how treatment can improve mentation, and 4) how to promote mobility and independence in this complex patient population.
