Understanding Oral Anticoagulation Use and Success Among Patients with Psychiatric Multimorbidity in Atrial Fibrillation

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Project Summary My long-term career goal is to become an independent pharmacist researcher with expertise in psychiatric multimorbidity research in cardiovascular disease. Through my research program I aim to identify factors that influence the health and medication taking behaviors of older adults with psychiatric multimorbidity using “real world” observational data and direct patient and stakeholder engagement. I have clinical (PharmD) and graduate (PhD) training in pharmacy and I am an assistant professor at Northeastern University in the Department of Pharmacy and Health Systems Sciences. Training facilitated by this K01 award will help me achieve my long- term career goal by building on my clinical and technical skills as a pharmacist and researcher and providing me with the protected time necessary to expand my expertise in longitudinal data analysis, mixed methods and patient-centered research in cardiovascular disease and multimorbidity. I have assembled an outstanding, committed, and interdisciplinary team of nationally renowned experts in fields relevant to the proposed research and my long-term goals. My training plan complements my prior training and experience and incorporates interaction with mentors, formal coursework, hands-on training, workshops, conferences and research activities. Using a mixed methods design, my proposal seeks to build and expand on my preliminary work completed in partnership with the ongoing NHLBI funded study, Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF). I will leverage observational data, currently being collected in SAGE-AF, to evaluate the longitudinal impact of psychiatric multimorbidity (i.e., dyads and the triad of depression, anxiety and cognitive impairment) on oral anticoagulant (OAC) use and outcomes in patients with atrial fibrillation (AF). I will examine relationships between psychiatric multimorbidity and clinical outcomes such as bleeding and medication adherence. I will also examine relationships between psychiatric multimorbidity and patient reported outcomes that are not readily available in the medical record but are increasingly important to patients, their families and clinicians such as patient satisfaction and health-related quality of life. Then, I will conduct focus groups of SAGE- AF participants (92% report willingness to continue in SAGE-AF) and stakeholders to understand protective factors that influence anticoagulation success among patients with psychiatric multimorbidity, including factors that are not evaluated in the SAGE-AF data. The specific aims are to: 1) Examine the relationship between psychiatric multimorbidity and OAC prescribing in AF; 2) Among OAC users, examine longitudinal associations between psychiatric multimorbidity and OAC success indicators and patient reported outcomes over 2 years; and 3) Conduct 6-8 qualitative focus groups including SAGE-AF participants, their caregivers and their clinicians, to identify factors that influence OAC success. This proposal aligns with NHLBI’s overarching objective 3 by investigating factors that account for differences in health among populations and has high potential to identify factors that can be useful targets for patient-centered interventions.