Heart Failure and Beta-Blocker Use in Older Adults

描述(申请人提供)：本次修订的NIA K23奖项申请(1 K23 AG19211-01A1)的目的是为候选人Ali Ahmed，医学博士，公共卫生硕士提供额外的培训和研究经验，使他能够成为老年结局研究的独立研究员，特别关注心力衰竭。艾哈迈德博士对阿拉巴马州质量保证基金会(AQAF)数据库(N=1,000)进行了二次分析，以研究ACE抑制剂在老年人心力衰竭中的相关性和结果。在过去四年中，这些研究产生了15份初稿(1份已出版，9份在出版/接受，3份在审查中，2份在准备中)。在目前的申请中，他建议以他以前在健康服务和流行病学研究方面的经验为基础，对CMS资助的阿拉巴马州心力衰竭项目(N=10,000)衍生的一个更大的数据库进行一系列分析，反映1998至2001年间出院的心力衰竭病例。他的研究将使他能够确定β受体阻滞剂使用的相关性，以及在患有心力衰竭的老年人中，β受体阻滞剂的使用与一年死亡率和住院之间的联系。应聘者将学习和使用先进的结果研究方法，如用于风险调整的多变量模型，包括倾向分数和工具变量。他还建议在获奖期的最后三年进行一项试点干预研究，以增加ACE抑制剂和β-受体阻滞剂在患有心力衰竭的老年人中的使用。他计划利用这些研究的结果和经验，在获奖期的最后两年申请R01研究基金。此外，他还将与医学博士Louis Dell‘Italia(UAB心脏学和生理学)合作制定一项试点研究计划，以提供对上述研究的重要发现之一的机械学见解。艾哈迈德博士提出了一项职业发展计划，其中包括在阿拉巴马大学伯明翰分校(UAB)和AQAF的课程和实地工作。他的主要赞助人Richard M.AIIman医学博士(UAB老年病学)和共同赞助人Louis Dell‘Italia医学博士和Catarina Kiefe博士(UAB预防医学和生物统计学)将与其他UAB和外部教员组成的团队合作，监督他的培训和研究活动。毕业于NIA老龄化夏季研究所和NIH K30临床研究培训项目，他的长期目标是在以患者为中心的老年人心力衰竭结果研究领域取得独立的研究员地位，研究与老年心力衰竭结果相关的各种因素，并设计适当的干预措施来改善结果。拟议的培训和研究将为他提供必要的技能和经验，使他的职业生涯进入下一阶段，成为涉及老年人心力衰竭的结果研究的独立调查员。

DESCRIPTION (provided by applicant): The purpose of this revised NIA K23 award application (1 K23 AG19211-01A1) is to provide the candidate, Ali Ahmed, MD, MPH, a fellowship trained geriatrician with additional training and research experience that will enable him to become an independent investigator in geriatric outcomes research with a special focus on heart failure. Dr. Ahmed has conducted secondary analyses of an Alabama Quality Assurance Foundation (AQAF) database (N =1,000) to study correlates and outcomes of ACE inhibitors in older adults with heart failure. These studies have resulted in fifteen first-authored manuscripts (one published, nine in press/accepted, three under review and two in preparation) over the last four years. In this current application, he proposes to build upon his previous experience in health services and epidemiological research to conduct a series of analyses of a much larger database derived from the CMS-funded Alabama Heart Failure Project (N = 10,000), reflecting heart failure cases discharged between 1998 and 2001. His research will permit him to define correlates of beta-blocker use and the association between beta-blocker use and one-year mortality and hospitalization in older adults with heart failure. The candidate will learn and use advanced outcomes research methodologies such as multivariate models for risk adjustment, including propensity scores and instrumental variables. He also proposes to conduct a pilot intervention study during the last three years of the award period to increase the use of ACE inhibitor and beta-blockers in older adults with heart failure. He plans to use the results and the experience of these studies to apply for an R01 research grant during the last two years of the award period. In addition, he will also develop plans for a pilot study in collaboration with Louis Dell'Italia, MD (UAB Cardiology and Physiology) to provide mechanistic insight into one of the important findings of the above studies. Dr. Ahmed proposes a career development plan that includes coursework and fieldwork at the University of Alabama at Birmingham (UAB) and at the AQAF. His primary sponsor Richard M. AIIman, MD (UAB Geriatrics) and co-sponsors Louis Dell'Italia, MD and Catarina Kiefe, PhD, MD (UAB Preventive Medicine and Biostatistics), in collaboration with a team of other senior UAB and external faculty will supervise his training and research activities. A graduate of the NIA Summer Institute on Aging Research and NIH K30 Clinical Research Training Program, his long-term goal is to attain independence as an investigator in the field of patient-oriented heart failure outcomes research in older adults and study various factors associated with outcomes in older adults with heart failure and to design appropriate interventions to improve outcomes. The proposed training and research will provide him the necessary skills and experience to advance his career to the next phase, in becoming an independent investigator in outcomes research involving heart failure in older adults.