Heart Failure and Beta-Blocker Use in Older Adults

描述（由申请人提供）：此修订后的NIA K23奖申请（1 K23 AG 19211 - 01 A1）的目的是为候选人Ali Ahmed，MD，MPH，一位受过奖学金培训的老年病学家提供额外的培训和研究经验，使他能够成为老年病结局研究的独立研究者，特别关注心力衰竭。Ahmed博士对亚拉巴马质量保证基金会（AQAF）数据库（N = 1，000）进行了二次分析，以研究ACE抑制剂在老年心力衰竭患者中的相关性和结局。在过去的四年里，这些研究产生了15篇第一作者的手稿（1篇已出版，9篇已出版/已接受，3篇正在审查，2篇正在编写）。在目前的应用中，他建议根据他以前在卫生服务和流行病学研究方面的经验，对来自CMS资助的亚拉巴马心力衰竭项目（N = 10，000）的更大数据库进行一系列分析，反映1998年至2001年期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β受体阻滞剂使用与老年心力衰竭患者一年死亡率和住院率之间的关联。候选人将学习和使用先进的结果研究方法，如风险调整的多变量模型，包括倾向评分和工具变量。他还建议在奖励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受体阻滞剂在老年心力衰竭患者中的使用。他计划利用这些研究的结果和经验，在奖励期的最后两年申请R 01研究补助金。此外，他还将与Louis Dell'Italia，MD（UAB心脏病学和生理学）合作制定试点研究计划，为上述研究的重要发现之一提供机制见解。艾哈迈德博士提出了一个职业发展计划，其中包括在伯明翰（UAB）的亚拉巴马大学和AQAF的课程和实地考察。他的主要赞助商理查德·M。医学博士（UAB老年医学）和共同赞助商路易斯戴尔'意大利，医学博士和卡塔里纳基夫，博士，医学博士（UAB预防医学和生物统计学），与其他高级UAB和外部教师团队合作，将监督他的培训和研究活动。他毕业于NIA老龄化研究夏季研究所和NIH K30临床研究培训计划，他的长期目标是在老年人以患者为导向的心力衰竭结局研究领域获得独立性，并研究与心力衰竭老年人结局相关的各种因素，并设计适当的干预措施以改善结局。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结局研究的独立研究者。

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.