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
Schools of Medicine
United States
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Breathett, Khadijah; Allen, Larry A; Ambardekar, Amrut V (2016) Patient-centered care for left ventricular assist device therapy: current challenges and future directions. Curr Opin Cardiol 31:313-20
Breathett, Khadijah; Allen, Larry A; Udelson, James et al. (2016) Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction. Circ Heart Fail 9:
Allen, Larry A; Ambardekar, Amrut V (2016) Hashing It Out Over Cannabis: Moving Toward a Standard Guideline on Substance Use for Cardiac Transplantation Eligibility That Includes Marijuana. Circ Heart Fail 9:
Kociol, Robb D; Allen, Larry A (2016) Gradual Increases in Scheduled and Actual Early Follow-Up After Heart Failure Hospitalization: Two Steps Forward or One Step Forward? Circ Heart Fail 9:
DeVore, Adam D; Allen, Larry A; Eapen, Zubin J (2015) Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions. J Card Fail 21:667-73
McIlvennan, Colleen K; Matlock, Daniel D; Narayan, Madhav P et al. (2015) Perspectives from mechanical circulatory support coordinators on the pre-implantation decision process for destination therapy left ventricular assist devices. Heart Lung 44:219-24
Allen, Larry A; Fonarow, Gregg C; Liang, Li et al. (2015) Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures. Circulation 132:1347-53
Allen, Larry A; Fonarow, Gregg C; Simon, DaJuanicia N et al. (2015) Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort. J Am Coll Cardiol 65:2691-8
McIlvennan, Colleen K; Eapen, Zubin J; Allen, Larry A (2015) Hospital readmissions reduction program. Circulation 131:1796-803
McIlvennan, Colleen K; Jones, Jacqueline; Allen, Larry A et al. (2015) Decision-making for destination therapy left ventricular assist devices: implications for caregivers. Circ Cardiovasc Qual Outcomes 8:172-8

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