Year 2. June 25. Getting to the Heart of the Matter.
Cardiovascular disease remains the major cause of death worldwide. Faculty in the cardiovascular division within our department, remain at the forefront of innovative patient care, training the next generation of cardiologists and of course leading in research. This week, I spotlight some recent research and clinical achievements by members of our cardiology division.
Xinjiang Cai, MD, PhD Awarded K08 Mentored Clinical Scientist Research Career Development Award
Xinjiang Cai, MD, PhD, from the division of cardiology, was recently awarded a 5-year, K08 Mentored Clinical Scientist Research Career Development Award from the National Heart, Lung, and Blood Institute. KO8 awards provide physician scientists with support and protected research time to work on a significant health-related research project. This support enables emerging physician scientists to establish a research area on which a long-term research career can be launched. Xinjiang is a recent graduate of the UCLA Specialty Training and Advanced Research (STAR) Program. The award will support the project, "Regulation of Vascular Calcification by Adventitial Endothelial Cells."
He shares the following about his research:
"Vascular calcification is the pathological deposition of minerals in the walls of the blood vessels, leading to the hardening and increased stiffness of arterial walls, and increased cardiovascular morbidity and mortality. In this proposal, we aim to define the effects of endothelial cells on the development and progression of atherosclerotic calcification and identify the unique molecular signature of endothelial cells. The completion of the proposed studies may pave the way to develop novel therapeutic strategies to selectively target these endothelial cells, thereby attenuating atherosclerotic calcification."
As a clinician, Xinjiang is passionate about improving patient-centered clinical care and cardiovascular health in patients and the general population, while conducting basic and translational cardiovascular research to improve patient care. He adds,
“I am incredibly grateful to my mentor Dr. Kristina Bostrom, my K08 committee, colleagues, and friends who have provided me with guidance, support and expertise instrumental in shaping my research endeavors. I am truly fortunate to have had the opportunity to receive my training at our UCLA Cardiology Fellowship Program and the Specialty Training and Advanced Research (STAR) Program. I would also like to express my gratitude to our division and department leadership and the entire community in the department of medicine for their continuous support and dedication to scientific research.”
Jesus Araujo, MD, MSC, PhD Awarded NIH-NIEHS National Institute of Environmental Health Sciences Research Supplement Award for R01
You have all seen the pictures of the smoke-filled air in east coast cities like New York City, given the wildfires burning across Canada. In fact, I heard this morning that the worst air quality in the world this morning is in Montreal. One of our faculty Jesus Araujo, MD, MSC, PhD, from the division of cardiology, is a world leader in studies of the impact of the associated particulate matter (PM) on human health. Therefore, it is timely to highlight his recently awarded grant.
Jesus received supplemental funding for his R01 project titled, “Dissecting the Role of Arachidonic Acid Metabolic Pathways Involved in Resolution Versus Progression of PM-Induced Cardiometabolic Toxicity.” His lab at UCLA focuses on two areas of investigation. One focus includes environmental cardiology to determine how PM impacts atherosclerosis and ischemic heart disease, and how gene-environment interactions impact the development of cardiovascular disease. The second focus includes the biology of oxidative stress. His initial R01 award from the NIH-NIEHS aims to dissect the molecular pathways involved in the development and advancement of inflammation in cardiometabolic syndrome due to ambient PM, such as diesel exhaust and ultrafine particles. The project aims to understand the prevention and treatment of PM induced toxicity leading to cardiometabolic syndromes. Dr. Araujo shares:
“The additional funding will enable us to extend the scope of our project to now study the neuroinflammatory effects of air pollution in the development of Alzheimer’s disease together with the initially proposed study of cardiometabolic effects.”
Securing additional NIH funding truly reflects the contributions of a dedicated team that includes administrative support to ensure that administrative requests are accomplished quickly and accurately. Dr. Araujo and I acknowledge the administrative team comprised of Director of Research Administration Catherine Rujanuruks, Program Manager Sandra Perez, and Management Services Officer Stephanie Hope who were essential in ensuring that NIH administrative requirements were complete. Go team!
Kalyanam Shivkumar, MD, PhD Awarded Leducq International Network of Excellence Program Award
Kalyanam Shivkumar, MD, PhD has been awarded an $8 million grant from the prestigious Leducq International Network of Excellence Program Award. Working alongside researchers from Oxford University, the team will set up a network of leading scientists from the United States and Europe to develop bioelectronics and therapies that focus on the nervous system in the treatment of heart rhythm disorders.
Their efforts will seek to diagnose and treat these conditions with neuromodulation technologies which will address dysfunction in the autonomic nervous system which has been shown to have a significant role in the development of ventricular arrhythmias and sudden cardiac death.
Additional research institutions participating in the UCLA-Oxford led network include John Hopkins University, Northwestern University, and the University of Bordeaux.
Cardiology Team at UCLA Health Awarded Get With The Guidelines® Heart Failure Gold Plus Award
Congratulations to the multidisciplinary cardiology team at Ronald Regan UCLA Medical Center who were recently awarded the Get With The Guidelines® Heart Failure Gold Plus Award from the American Heart Association. Interim Chief of the Division of Cardiology Gregg C. Fonarow, MD shares that UCLA Health earned this award by meeting specific achievement measures for the diagnosis and evidence-based treatment of heart failure. This award recognizes the exceptional team of cardiology experts who have been committed to providing exceptional heart failure care and improving clinical outcomes. The award also honors the department of medicine's and UCLA Health’s commitment to ensuring patients with heart failure receive the most appropriate and timely treatment according to nationally recognized, research-based guidelines founded in the latest scientific evidence. Dr. Fonarow adds:
"We are very proud to be participating in Get With The Guidelines-Heart Failure and have achieved this national recognition from the American Heart Association. By applying this highly effective system of care, we are able to more effectively measure and improve the delivery of science-based heart failure care and guidelines developed to improve patient clinical outcomes.”
10th Annual UCLA Health Resident Informaticist Project Virtual Symposium
Our clinicians are busier than ever. Yet, there are many hurdles that frustrate their best intentions as they care for their patients. A select group of our residents recently graduated from the UCLA Health Resident Informaticist Program. Their projects focused on creating tools that remove barriers that our physicians face in providing safe and effective care.
Last year, we introduced you to six DoM residents participating in the UCLA Health Resident Informaticist Program. These residents worked alongside UCLA Health faculty and UCLA Health Information Technology (I.T.) to develop projects that streamline and leverage the electronic health record with the goal of improving workflow efficiency, adopting transformation technologies, and increasing patient quality and safety. Four members of this cohort presented their culminating projects at the 10th Annual UCLA Health Resident Informaticist Project Virtual Symposium. These presentations demonstrate their focus on creating tools that will directly impact our ability to efficiently implement guideline-directed treatments in diverse conditions. Their projects are summarized below.
As an endocrinology fellow, Dr. Downs wanted to focus his project in advancing the treatment of diabetes and obesity by addressing a care gap in the prescription of GLP1 receptor agonists (GLP1RA), which are increasingly being used, given their effectiveness in diabetes and obesity management. GLP1RA prescriptions are being more widely prescribed by primary care providers. However, prescriptions and doses for members of this class of medication are not interchangeable depending on whether they are being prescribed for obesity or diabetes. This has led to difficulty in the adoption of this treatment and errors in prescription. As a solution, Dr. Downs developed two SmartSets, one for diabetes and one for obesity, to help prescribe GLP1RA medications. Each SmartSet provides easily accessible, comprehensive medication information when needed, gives pre-populated intuitive orders for each stage of medication initiation, allows medication instructions to be easily inserted, and provide referrals to ancillary support services. Dr. Downs will continue to optimize visibility, incorporate feedback from providers, and add new medications from the expanding drug class, by collecting data about use and efficiency of the Smart Sets.
Project Title: Enhancing the NICU Feeding Summary in EPIC
Caring for patients in the neonatal intensive care unit (NICU) requires ensuring that they are receiving optimal nutrition. In “Enhancing the NICU Feeding Summary in EPIC,” Dr. Erondu noted that NICU feeding summaries are in different sections in EPIC, which can lead to errors in collecting data, and residents spending over 15 minutes per visit with patients calculating daily fluid and calorie intake data. Sixty-six percent of residents expressed that they are dissatisfied with the process. With her project, Dr. Erondu sought to decrease pre-rounding time, reduce calculation errors, and improve resident satisfaction. Her solution included a NICU feeding summary that includes a consolidated summary of micronutrients. She created a dot phrase with reference formulas for calculating caloric intake, and a NICU storyboard feature allowing residents to update NICU weight. As the project rolls out, Dr. Erondu will be assessing whether there is a decrease in errors in the collection of data and an improvement in resident satisfaction.
Project Title: Improving Pre-exposure Prophylaxis for HIV (PrEP) Management in Primary Care
Dr. Troung presented evidence that although Pre-exposure Prophylaxis for HIV (PrEP) is successful at preventing transmission of HIV, thereby reducing health care costs, there has been a low prescription rate for eligible patients. His project sought to simplify workflows and improve education about PrEP for primary care providers. Currently, a PrEP prescription requires 10+ orders to initiate and 5+ orders for each quarterly clinic visit, which may result care gaps due to suboptimal clinic and cost management of orders or visits. Dr. Truong updated a Smart Set to include standardized orders, decision support, and cues for providers and patients to initiate and monitor PrEP. With implementation of the updated Smart Set in May 2023, his anticipated outcomes include decreasing the administrative burden of placing a PrEP order, increasing patient satisfaction with PrEP counseling, and cost savings associated with conversions of prescriptions of Descovy and Truvada to generic preparations containing their active ingredients, emtricitabine and tenofovir.
Resident: Wendi LeBrett, MD
Mentor: Magdalena Ptaszny, MD
Project Title: Inpatient GI Bleed Admission Smart Group
In the Bundled Payments for Care Improvement (BPCI) initiative, the Centers for Medicare and Medicaid Services identified gastrointestinal hemorrhage as an inpatient clinical episode where healthcare expenditure and quality of care is a priority. Dr. LeBrett’s review of the literature found that off-hour hospital admissions for gastrointestinal bleeding resulted in worse clinical outcomes and increased mortality in patients, particularly for patients admitted through medicine. With the goal of reducing inappropriate diet orders, increasing GI bleed medications and orders of coagulation factors, she proposed a solution to include a dynamic smart group for GI bleed admissions within the medicine general admission order set for medicine admissions. The smart group includes standard orders for diets, labs, medications, and provides transfusion guidelines for patients with and without cirrhosis. These efforts could reduce the time to endoscopy, length of stay, and costs associated with GI bleed admission. The order panel has been completed and went live on June 20th and will be undergoing pre and post implementation analysis that will be included in a publication and ultimately expanded throughout the health system.
Congratulations to our resident informaticists whose efforts are seeking to get to the heart of the matter, as it relates to improving quality and safety.
Catherine A. Sarkisian, MD Named a UCLA Health All Star at Dodger Stadium
Last Friday, if you were watching the Los Angeles Dodgers game, you may have noticed a familiar face at the pitching mound at Dodger Stadium. DoM faculty Catherine A. Sarkisian, MD was recognized as a UCLA Health All Star and threw out the first pitch of the game! She set the Dodgers up for success as they won the game against the Houston Astros!
Dr. Michael Jiang is a cardiology fellow who was one of two recipients of the Outstanding Teaching by a Fellow Award at this year’s internal medicine residency graduation. I show this picture to make the case that Mike shares my good taste in neckties.