This is a NIH Pathway to Independence Award (K99/R00) grant proposal, intended to promote the career of Dr. Christy Avery, PhD, a post-doctoral fellow at the University of North Carolina, into a path of independent research. The Candidate is a trained epidemiologist with a significant track record of research in the field of cardiovascular disease epidemiology. Her goal is to integrate these skills with focused training in clinical research to become an independent scientist at the interface of basic science, clinical practice, and population research. The topical area for the proposed experiential development is translational research in heart failure. During the mentored K99 phase the Candidate will expand her clinical research skills by interacting with clinical specialists who are productive scientists in heart failure research, engaging in formal didactics, attending multidisciplinary seminars, journal clubs, and scientific meetings, participating study activities with her mentors, and by leading a project that develops novel heart failure classification tools applicable to clinical practice and population research. These activities will be supervised by mentor Dr. Gerardo Heiss MD PhD, Kenan Professor of Epidemiology and co-mentor Dr. Patricia Chang, MD MHS FACC, Assistant Professor of Medicine. In addition, a team of collaborators with complementary areas of expertise will supplement Dr. Avery's training in specific areas. Together, the mentor, co-mentor, and collaborators are fully committed to assisting the Candidate reach her research training and career development goals and to ensuring the Candidate's successful transition from postdoctoral fellow to independent researcher. During the independent R00 award phase, the Candidate will apply the tools developed during the K99 component in the cohort of the ongoing Atherosclerosis Risk in Communities (ARIC) Study. For this purpose the ARIC study investigators are making available data on the cohort's follow-up calls, their physician visits, emergency department visits and hospitalizations, and the associated diagnoses. This information base will be combined with outpatient and inpatient Medicare claims data and reports by participant's treating physicians to estimate the burden of heart failure and its patterns of diagnosis and care in ARIC Study participants. The Candidate also will characterize the transition from heart failure managed in outpatient settings to acute/decompensated heart failure events requiring hospitalization. The proposed research is both novel and of major potential for translation, with possible relevance for early diagnosis and proactive management of heart failure as well as for health services allocation and program evaluation. The short term benefits from this study will be a contribution to the under- studied area of quantifying the outpatient burden of HF and its secular trends in communities.

Public Health Relevance

PROJECT NARRATIVE Heart failure is a common, costly, disabling, and often fatal disorder that places a tremendous burden on healthcare systems worldwide. Estimates of the community heart failure burden are essential for health services allocation and program evaluation, yet few programs quantifying the burden of heart failure currently exist. Results from this study will help measure the prevalence of heart failure and how it has changed through time in the United States.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Career Transition Award (K99)
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Special Emphasis Panel (ZHL1-CSR-Z (O2))
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Cooper, Lawton S
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University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
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Hardy, Shakia T; Holliday, Katelyn M; Chakladar, Sujatro et al. (2017) Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States. JAMA Cardiol 2:653-661
Evans, Daniel S; Avery, Christy L; Nalls, Mike A et al. (2016) Fine-mapping, novel loci identification, and SNP association transferability in a genome-wide association study of QRS duration in African Americans. Hum Mol Genet 25:4350-4368
Caughey, Melissa C; Avery, Christy L; Ni, Hanyu et al. (2014) Outcomes of patients with anemia and acute decompensated heart failure with preserved versus reduced ejection fraction (from the ARIC study community surveillance). Am J Cardiol 114:1850-4
Seyerle, Amanda A; Young, Alicia M; Jeff, Janina M et al. (2014) Evidence of heterogeneity by race/ethnicity in genetic determinants of QT interval. Epidemiology 25:790-8
Butler, Anne M; Yin, Xiaoyan; Evans, Daniel S et al. (2012) Novel loci associated with PR interval in a genome-wide association study of 10 African American cohorts. Circ Cardiovasc Genet 5:639-46
Agarwal, Sunil K; Avery, Christy L; Ballantyne, Christie M et al. (2011) Sources of variability in measurements of cardiac troponin T in a community-based sample: the atherosclerosis risk in communities study. Clin Chem 57:891-7
Avery, Christy L; He, Qianchuan; North, Kari E et al. (2011) A phenomics-based strategy identifies loci on APOC1, BRAP, and PLCG1 associated with metabolic syndrome phenotype domains. PLoS Genet 7:e1002322