This is the second submission for a K23 award (PA-10-060) to the NHLBI by Larry A. Allen, MD, MHS. Candidate: Dr. Allen is an Assistant Professor of Medicine in the Division of Cardiology at the University of Colorado Denver (UCD) with a clinical focus in advanced heart failure and cardiac transplantation. He has completed a Master in Health Sciences and conducted several studies focused on clinical outcomes for patients with heart failure. He now works within the Colorado Cardiovascular Outcomes Research Consortium (CCOR), is an Affiliate Investigator at Kaiser, and is the natural lead for projects related to heart failure. Training: The proposed K23 career development plan builds on prior experience from fellowship and early career development to focus on three primary topical areas that require additional training: 1) longitudinal data analysis, 2) qualitative methods, and 3) implementation science. Accordingly, Dr. Allen proposes intensive topical mentorship, focused coursework and seminars, and contextual learning through the proposed research. These training activities will enable Dr. Allen to better leverage his current access to integrated health care systems so that he may improve health outcomes for patients with heart failure. Mentors/Environment: The primary mentor, John Rumsfeld, MD, PhD, is a Professor at UCD, co-director of CCOR, and Chair of the Advisory Committee for the Cardiovascular Research Network (CVRN). Co-mentor, David Magid, MD, MPH, is co-director of CCOR, Co-PI of the CVRN, and Director of Research at Colorado Permanente Medical Group;these entities will provide the clinical setting and research infrastructure for this K23. Fred Masoudi, MD, MSPH (career development), Diane Fairclough, DrPH (longitudinal data analysis), Debbi Main, PhD (qualitative methods), and Paul Estabrooks, PhD (implementation science) will complete a multidisciplinary mentorship team that will ensure the completion of Dr. Allen's research and training activities. Research: There is a pressing need to develop strategies to optimize the utilization of proven therapies for chronic heart failure in order to improve clinical outcomes-primary among them readmission-and control costs. This K23 proposal challenges the current paradigm of reactive, physician-driven, diuretic-based disease management interventions. This study will: 1) address the long-term intensification, safety monitoring, and adherence to heart failure medications, which have largely been ignored to date;and 2) develop and pilot test a novel heart failure care model involving proactive, electronic health record-informed, pharmacist-coordinated services focused on optimizing the use of heart failure medications. Summary: Conduct of this mentored research and training proposal, "Addressing Gaps in Longitudinal Heart Failure Pharmacotherapy to Reduce Rehospitalization", will facilitate Dr. Allen's development into a nationally- recognized independent investigator, working to promote practical interventions which support the use of efficacious therapies, reduce readmissions, and improve the quality of life for patients with heart failure.

Public Health Relevance

Heart failure is a major and growing public health problem, resulting in 1.1 million hospitalizations annually and a readmission rate of over 50% within 6 months. Preliminary work from our group and others suggests that gaps in the ongoing use and monitoring of heart failure medications are common and may be an important modifiable cause of hospital readmission. The objective of this project is to produce new practical knowledge that will improve the use of proven therapies for chronic heart failure and have direct public health benefits for millions of Americans living with heart failure.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-X (M1))
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Scott, Jane
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University of Colorado Denver
Internal Medicine/Medicine
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United States
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McIlvennan, Colleen K; Magid, Kate H; Ambardekar, Amrut V et al. (2014) Clinical outcomes after continuous-flow left ventricular assist device: a systematic review. Circ Heart Fail 7:1003-13
McIlvennan, Colleen K; Allen, Larry A; Nowels, Carolyn et al. (2014) Decision making for destination therapy left ventricular assist devices: "there was no choice" versus "I thought about it an awful lot". Circ Cardiovasc Qual Outcomes 7:374-80
Allen, Larry A; Fonarow, Gregg C; Grau-Sepulveda, Maria V et al. (2014) Hospital variation in intravenous inotrope use for patients hospitalized with heart failure: insights from Get With The Guidelines. Circ Heart Fail 7:251-60
Allen, Larry A; Rumsfeld, John S (2014) Can we predict who will be alive and well after transcatheter aortic valve replacement? Is that useful to individual patients? Circulation 129:2636-7
Allen, Larry A; Yood, Marianne Ulcickas; Wagner, Edward H et al. (2014) Performance of claims-based algorithms for identifying heart failure and cardiomyopathy among patients diagnosed with breast cancer. Med Care 52:e30-8
Flint, Kelsey M; Allen, Larry A; Pham, Michael et al. (2014) B-type natriuretic peptide predicts 30-day readmission for heart failure but not readmission for other causes. J Am Heart Assoc 3:e000806
McIlvennan, Colleen K; Allen, Larry A (2014) Outcomes in acute heart failure: 30-day readmission versus death. Curr Heart Fail Rep 11:445-52
Allen, Larry A; Ambardekar, Amrut V; Devaraj, Kalpana M et al. (2014) Clinical problem-solving. Missing elements of the history. N Engl J Med 370:559-66
Allen, Larry A; Shetterly, Susan M; Peterson, Pamela N et al. (2014) Guideline concordance of testing for hyperkalemia and kidney dysfunction during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure. Circ Heart Fail 7:43-50
Clarke, Christina L; Grunwald, Gary K; Allen, Larry A et al. (2013) Natural history of left ventricular ejection fraction in patients with heart failure. Circ Cardiovasc Qual Outcomes 6:680-6

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