OVERVIEW: The purpose of this application is to support the patient-oriented research program and career development of Margaret C. Fang, MD, MPH, a fellowship-trained academic hospitalist at the University of California, San Francisco (UCSF). Dr. Fang's overall career goal is to optimize stroke prevention in older patients with atrial fibrillation. She will develop a research program that will explore clinical and biological risk factors for stroke and hemorrhage associated with atrial fibrillation, identify the optimal use of anticoagulants to prevent atrial Fibrillation-related stroke, direct attention towards social and behavioral barriers to optimal anticoagulant management, and test interventions directed at improving clinical decision-making in regards to anticoagulating the oldest patients. CAREER DEVELOPMENT PLAN: Dr. Fang will undergo formal didactic training and conduct mentored clinical research over the 5 year award period. Didactic training will include coursework and tutorials in outcomes assessment, propensity score analysis, cost-effectiveness analysis, genetic epidemiology, functional status assessment, and the sociology and biology of aging. She will obtain training in clinical geriatrics through enrolling in the UCSF Core Geriatrics Curriculum. An advisory committee of senior investigators, led by Dr. Seth Landefeld, the Chief of Geriatrics at UCSF and her Principal Mentor, will oversee all aspects of Dr. Fang's career development. RESEARCH PLAN:
The aims of this researchapplication are to (1) determine how advanced age affects warfarin control and poor outcomes from warfarin;(2) assess whether functional decline, fall-risk, and cognitive impairment lead to worse outcomes on warfarin;and (3) develop and pilot test a decision tool that helps Clinicians compare the risks and benefits of prescribing warfarin for older patients with atrial fibrillation.
These aims will be accomplished through 3 projects. In Project 1, Dr. Fang will analyze data from the ATRIA cohort of 13,559 people with atrial fibrillation to determine age-specific rates, risk factors, and outcomes of warfarin-associated hemorrhage and warfarin control. In Project 2, Dr. Fang will assemble a cohort of frail community-dwelling elders with atrial fibrillation to study how frailty is associated with warfarin control and outcomes. In Project 3, Dr. Fang will develop a clinical decision tool, incorporating data obtained from the first two studies, to assist clinicians decide on the optimal choice of antithrombotic therapy for older patients with atrial fibrillation. This decision tool will then be pilot tested among clinicians caring for patients with atrial fibrillation at UCSF. Together, these projects will provide practical experience and form the basis for future studies that seek to improve the safety and use of anticoagulants in the oldest patients with atrial fibrillation.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG028978-04
Application #
7657357
Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (M1))
Program Officer
Nayfield, Susan G
Project Start
2006-09-01
Project End
2011-08-31
Budget Start
2009-09-01
Budget End
2010-08-31
Support Year
4
Fiscal Year
2009
Total Cost
$161,843
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Ashburner, Jeffrey M; Go, Alan S; Chang, Yuchiao et al. (2017) Influence of Competing Risks on Estimating the Expected Benefit of Warfarin in Individuals with Atrial Fibrillation Not Currently Taking Anticoagulants: The Anticoagulation and Risk Factors in Atrial Fibrillation Study. J Am Geriatr Soc 65:35-41
Ashburner, Jeffrey M; Go, Alan S; Chang, Yuchiao et al. (2016) Effect of Diabetes and Glycemic Control onĀ Ischemic Stroke Risk in AF Patients: ATRIA Study. J Am Coll Cardiol 67:239-47
Fang, Margaret C; Go, Alan S; Chang, Yuchiao et al. (2014) Long-term survival after ischemic stroke in patients with atrial fibrillation. Neurology 82:1033-7
Fang, Margaret C; Coca Perraillon, Marcelo; Ghosh, Kaushik et al. (2014) Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008. Am J Med 127:608-15
Singer, Daniel E; Chang, Yuchiao; Borowsky, Leila H et al. (2013) A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc 2:e000250
Fang, Margaret C; Go, Alan S; Chang, Yuchiao et al. (2012) Thirty-day mortality after ischemic stroke and intracranial hemorrhage in patients with atrial fibrillation on and off anticoagulants. Stroke 43:1795-9
Fang, M C; Maselli, J; Lurie, J D et al. (2011) Use and outcomes of venous thromboembolism prophylaxis after spinal fusion surgery. J Thromb Haemost 9:1318-25
Khanna, Raman R; Karliner, Leah S; Eck, Matthias et al. (2011) Performance of an online translation tool when applied to patient educational material. J Hosp Med 6:519-25
Fang, Margaret C; Go, Alan S; Chang, Yuchiao et al. (2011) A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol 58:395-401
Mission, John F; Kerlan Jr, Robert K; Tan, Justin H et al. (2010) Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med 25:321-5

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