Year 3. October 28.
[Intro]
Amber Tang, MD Publishes New Research in Circulation: Heart Failure
I am delighted to share that third-year resident Amber Tang, MD has published a new study that establishes baseline metrics for the largest-ever nationwide heart failure initiative.
Under the guidance of UCLA cardiologist Gregg Fonarow, MD, Dr. Tang and a multi-institution team from Cedars-Sinai, Duke, Washington University, Stanford and more analyzed data on over 66,000 patients who had been hospitalized with heart failure. After measuring mortality, hospital readmission rates and number of days spent at home — a metric known as “home-time” — they found that only about 22% of patients experienced 100% home-time in the year after discharge, with Black patients having the least amount of home time compared to other races. For all patients, rates of readmission for heart failure were around 30%, and mortality at one year was 37%.
“These findings really highlight the persistently poor outcomes patients face after heart failure hospitalization with high rates of readmission and mortality as well as reductions in time spent at home,” Dr. Tang said. “Home-time is an interesting outcome that hasn't been fully characterized in heart failure, but it encompasses more traditional outcomes such as readmission and mortality as well as time spent at rehab facilities or nursing homes. The goal is to find a practical measure that can capture what is really important to patients—being healthy and at home.”
The results of the study will serve as a reimplementation baseline for the American Heart Association’s IMPLEMENT-HF trial. The goal of this initiative is to increase home-time for all patients with heart failure and reduce all-cause mortality by 5%. Interventions include a “learning healthcare system” with a quality improvement infrastructure and patient engagement tools that improve healthcare access.
“It will be exciting to see the impact of such a wide-ranging intervention on outcomes like home-time,” Dr. Tang said.
This new publication is Dr. Tang’s second this month and her fourth this year. On Oct. 2, JAMA Cardiology published her article on the global impact of implementing guideline-directed medical therapy (GDMT) in heart failure, a report that was co-authored by UCLA cardiologist Boback Ziaeian, MD, PhD and led by Dr. Fonarow. In August she published research led by Dr. Ziaeian that investigated disparities in ablations among patients hospitalized for ventricular tachycardia, and in February she published a review led by Dr. Fonarow that looked at interventions to improve GDMT implementation among patients with heart failure with reduced ejection fraction.
Dr. Tang is a research all-star, with four articles in high-impact journals since the start of her residency. When asked how she manages to be so productive as a researcher on top of the challenges of being a trainee, she credited the structure of UCLA’s internal medicine residency program.
“When you come in as an intern, there’s a lot of time and support for you to really learn how to be an intern and how to handle those clinical demands, because UCLA is a clinically rigorous program and it trains you to be clinically successful,” she said. “It can definitely be tough in a busy residency, but UCLA’s residency program allows for a lot of time and space for you to build your other interests on top of your clinical duties.”
Dr. Tang currently is using that time and space with her work on a randomized controlled trial that brings together the UCLA Department of Medicine (DoM), UCLA Anderson School of Management and the UCLA Division of Cardiology. Her team is looking at ways to use electronic health records to promote the closure of cardiology care gaps, such as optimizing the use of guideline-directed medical therapy or improving use of drugs like statins and aspirin for eligible patients.
“In the future I would love to do more projects like that, where you’re directly looking at how we can implement sustainable measures and initiatives to really improve the quality and delivery of care that patients are getting,” she said.
Dr. Tang encourages trainees who want to get involved in research to look for mentorship early on. She began her residency in the DoM Quality Improvement Scholars Program, in which residents who express an interest in QI are paired with a mentor on the DoM Quality Team. The program connected her with Wendy Simon, MD and later to Dr. Fonarow and other mentors in the cardiology division who were conducting QI research. “It’s been so great to be able to work with the true leaders of the field within UCLA,” Dr. Tang said. “I think that their mentorship and sponsorship of residents is really unparalleled, and it’s allowed me to be successful as a researcher.”
Amy Vandiver, MD, PhD Receives R01 and AFAR Grants for Mitochondrial Genome Research
The scholarship excellence continues with the fantastic news that dermatologist, researcher and STAR program alumnus Amy Vandiver, MD, PhD has received not one, but two grants for her work on the role of the mitochondrial genome in aging. Dr. Vandiver was recently awarded a K08 from the National Institutes of Health along with funding from the American Federation for Aging Research.
“I am so very grateful to the UCLA STAR program; to the UCLA Division of Dermatology; to my funding sources, the NIH and AFAR, to be giving me this funding so I can transition to being an independent PI to really understand the role of the mitochondria genome in aging and hopefully make a big difference for people experiencing age-related disease,” Dr. Vandiver said.
The NIH and AFAR grants will fund two separate projects. First, for her K08 research, Dr. Vandiver will apply two research methods she developed as a post-doctoral fellow to studying mutations in the mitochondrial genome, a set of DNA molecules that live within the cell’s mitochondria and enable it to produce the energy required to power cellular functions.
“That genome acquires mutations at a much higher rate than the nuclear genome, particularly in aging and when tissues are stressed, like when skin gets older and is exposed to the environment and sun,” Dr. Vandiver explained. “We haven’t been able to study those mutations due to technical limitations in sequencing them and a lack of cell culture models.”
To overcome that problem, Dr. Vandiver has created a cell sequencing method that allows researchers like her to better map where mutations are in the mitochondrial genome and to understand which ones are most common in aging tissues. She has also developed an induced pluripotent stem cell-based system that contains matched sets of cells, one with high levels of mitochondrial mutations and another with low levels. With her K08 funding, she will use that system to study what happens when mitochondrial mutations are present in different replicating cell types.
Dr. Vandiver will use her AFAR grant to see if she use RNA sequencing data to identify mutations in mitochondrial DNA. Just like DNA in the nuclear genome, DNA in the mitochondrial genome is transcribed to RNA. Usually, though, this data is thrown out when people do large RNA sequencing analyses. She and her mentor have attempted to circumvent this problem by identifying mitochondrial DNA mutations in DNA sequencing data, but their ability to do so is hampered by how difficult it is to get good mitochondrial DNA prior to sequencing.
Recently, however, they have realized that the RNA sequencing data others are generating and providing in large public databases might help them answer some of the questions they want to ask of mitochondrial DNA. They have already applied existing technologies that were used to identify mutations in nuclear RNA to the mitochondrial RNA sequence — a method that worked well to map large deletions and structural mutations in the mitochondrial genome. They’re in the process of publishing the results of that work.
The AFAR award helps them take the next step. “We’ll be able to apply this approach to about 500 existing RNA sequencing datasets from publicly-available data,” Dr. Vandiver said. Please join me in congratulating Dr. Vandiver on her funding! I am excited to see the many innovations that come from her work.
Utibe Essien, MD, MPH Named Emerging Leader in Health and Medicine by National Academy of Medicine
I am thrilled to announce that Utibe Essien, MD, MPH, a primary care physician and health disparities researcher based at the VA, was one of just 10 people across the country to be named a 2024 National Academy of Medicine Emerging Leader in Health and Medicine Scholar. He is the third member of the DoM faculty to be selected for this honor in recent years, following in the footsteps of Lucinda Leung, MD, MPH, PhD in 2023 and Alejandra Casillas, MD, MSHS in 2021.
Those of you who are familiar with Dr. Essien’s work studying pharmacoequity — a term he coined back in 2021 that has come to define a new discipline of health disparities — may find it surprising that he did not always see himself taking the path of a physician-scientist. In fact, there was a time when he almost gave up on research altogether.
“I thought, ‘I don’t have the skills, I don’t have the tools, I’m not good enough for this job,’” he recalled. But mentors like the ones he met during his faculty positions at Massachusetts General Hospital and UCLA transformed his perspective — and, in turn, have enabled him to make an impact on the lives of underserved patients. His studies have shed light on racial disparities in atrial fibrillation therapy, the treatment of opioid use disorders and much more.
“I think this award is really a culmination of the last ten years or so of my journey,” Dr. Essien said. “Thanks to my mentors, I’ve gone from not being able to envision myself as a researcher to feeling like I can really make an impact through research and science. To have NAM recognize that is pretty cool.”
Dr. Essien looks forward to the many things he will learn from NAM members and especially his fellow emerging leaders, a group that includes physicians and scientists who have experience working with the FDA, repurposing old drugs for rare diseases, working on clinical trials and studying the economics of healthcare. With all that brainpower around pharmacotherapy, Dr. Essien is especially excited to help plan the program’s annual conference next year — and already has ideas for a theme.
“I’m really excited about bringing everyone together around a pharmacoequity mission,” Dr. Essien said. “I think we have a really cool opportunity to bring our different areas of expertise together, to think about the therapeutic continuum and all the ways we can improve pharmacoequity, from drug development to clinical trials to ensuring people can afford their medications.”
While Dr. Essien welcomes this recognition as a testament to his own hard work, he also views it as a chance to lift up others in the DoM as well as raise the profile of the VA’s endeavors to make healthcare more equitable.
“Now I have the opportunity to tell everyone about this and encourage them to apply as well, especially folks who typically have been underrepresented in medicine,” Dr. Essien said. “I’m just trying to bring everyone else along with me.”
Folasade May, MD, PhD to Co-Lead Community-Partnered Clinical Trial with R01 Grant
Community-partnered research is critical to our mission to transform patient care. Folasade May, MD, PhD, MPhil has received a $3 million R01 grant from the National Institutes of Health to continue her health disparities research with Northeast Valley Health Corporation (NEVHC), one of the largest Federally Qualified Health Centers (FQHCs) in the country. Her work aims to solve a problem that she and her colleagues first identified in an earlier project at with NEVHC: As few as 18% of patients who receive abnormal test results on a preliminary screening for colon cancer go on to have a colonoscopy, a more comprehensive screening test that is essential for finding colon cancer early.
“We were really excited when our R01 was funded because it really represented a continuation of funding across a spectrum from discovery and understanding the problem to developing an intervention to fix the problem,” Dr. May said. She and co-PI Beth Glenn, PhD at the UCLA Fielding School of Public Health spent a year working on their grant proposal, which passed through the NIH’s approval process with flying colors.
“We’re very grateful. The NIH gave us the best score you can get on a grant, which means they are really excited about the work,” Dr. May said. “It was a first percentile score, and we were really encouraged that they also agree that this work is important.”
Colorectal cancer causes the second-most cancer deaths in the U.S. Tools like the fecal immunochemical test (FIT) offer a relatively easy way to check for cancer while it’s still highly treatable, but abnormal results require timely colonoscopy. Dr. May’s earlier research with NEVHC suggested that many patients at FQHCs never proceed to this critical second step. That’s because FQHCs, while providing invaluable primary care to under-resourced communities, are not always equipped to help patients get to specialists.
“Getting patients from these primary care facilities to a place like UCLA or to a cancer center is very tough,” Dr. May explained. “This grant is about helping primary care centers that are focused on underserved populations get the specialty care they need, particularly for patients who’ve undergone screening for colorectal cancer and the screening was abnormal.”
This complex problem requires complex solutions. With their R01 funding, Drs. May, Glenn, and their team are launching a randomized cluster trial at six of NEVHC’s sites across L.A. County, where they will test an intervention that works at multiple levels — patient, provider, and healthcare system — and has several different components. For example, patients receive information on the importance of scheduling follow-up colonoscopies after abnormal FIT results and may also be paired with navigators who help them go through each step of the process. Meanwhile, changes to electronic health records (EHR) systems will adjust how the FQHC communicates with specialist clinicians regards patients’ referrals and test results.
The trial is a testament to the power of academic-community partnerships. The team planned out interventions in collaboration with multiple community stakeholders, including NEVHC officials, administrators, doctors and even patients.
“Having stakeholders at the table at the table is critical for true community partnership—it is part of our scientific approach,” Dr. May explained.
The most important metric for the trial’s success will be the number of patients who complete colonoscopies within six months of an abnormal FIT result. The team wants to improve the rates from 18% to around 80%, the national goal for such screenings. They’ll also evaluate the interactions between patients and providers — how often a provider is ordering a colonoscopy, for instance — as well as barriers at the insurance level that might prevent a patient from being able to get their colonoscopy done quickly.
Dr. May hopes that her work with NEVHC serves as an example to the UCLA community that academic-community partnerships can result in meaningful research. Saving lives is the main motivation behind her decision to take on such a challenging task, and she views her work with underserved populations as her career’s calling.
“This is a disease that we think is 90% preventable. There’s no reason that it should be the number two cancer killer in the United States. And we know that it’s increasing in young people and that rates are high in Black individuals,” she said. “I feel really drawn to this area of science and to discovery to figure out ways that we can get that information out there and make sure that people know that just by participating in these relatively simple tests, they can save their lives. They can save the lives of their loved ones. They can be around for generations to come.”
Thanh Neville, MD Recognized in Human Atlas Art Project
Service to our Los Angeles community is one of our core values in the DoM. Pulmonologist and end-of-life care researcher Thanh Neville, MD, MSHS has made such an impact on L.A. that she was one of just 100 people selected for Alta / A Human Atlas of a City of Angels, an interdisciplinary art project that recognizes individuals who are driving social change in Los Angeles County through a limited-edition portrait book, exhibition, website, mobile app, and podcast titled Intersections: Los Angeles.
“I had never heard about the Human Atlas, and when I learned that it was a project that showcased ‘extraordinary individuals who leave remarkable social impact,’ I was honestly shocked to have been selected,” she recalled. “When they called me, I actually asked if it was a mistake!”
Dr. Neville later learned that she had indeed been nominated for the program by Wade Trimmer, president of The Change Reaction, who knew her through her work as the medical director of the 3 Wishes Program (3WP). 3WP is a palliative care initiative that helps clinicians elicit and implement final wishes for patients who are close to dying.
“In the world of academic medicine, my work with the 3 Wishes Program is non-traditional and often considered ‘not scientific’. Nonetheless, it is founded on the notion that human compassion, delivered by healthcare workers at the end of patients’ lives, is extremely important,” she said. “I am proud to be able to say that I have been able to build an academic career around such a simple but important concept. I hope that others will realize that following their passion, even when non-traditional, can still lead to important contributions to society.”
As a collaboration between the Getty Conservation Institute and London-based artist Marcus Lyon, Alta / A Human Atlas of a City of Angels includes portraits, a visualization of participants’ DNA and oral histories. It takes the form of public exhibits, a podcast and an interactive book, along with a mobile app where users can scan each participant’s portrait to hear them tell their story. The project will be on display in the First Floor Galleries at the Central Library of Los Angeles Public Library from Jan. 13 to April. 27, 2025 as part of PST ART.
“I am so incredibly honored and humbled to have been selected as someone who is making a meaningful impact in a city as large and diverse as Los Angeles,” Dr. Neville said. “It’s so rewarding to know that my work is recognized and acknowledged as leaving a lasting footprint on a city that I love.”
I encourage you to check out Dr. Neville’s profile on the project website and to visit the Alta / A Human Atlas of a City of Angels if you have the chance. Photos below!
Celebrating Dr. Judith S. Currier: Career Achievement Award Recipient
Join me in celebrating DoM Executive Vice Chair Judith Currier, MD, MSc, who has been honored with the Career Achievement Award from the Geisel School of Medicine for her incredible contributions to the field of infectious diseases, particularly in HIV/AIDS research. With over 280 peer-reviewed publications, Dr. Currier has consistently advanced our understanding of HIV therapeutics and the complexities of cardiovascular complications associated with the virus. As chair of the NIH-sponsored AIDS Clinical Trials Group (ACTG), she has played a pivotal role in shaping national and international HIV care standards. Dr. Currier's innovative research also addresses gender-related issues in HIV treatment, ensuring that women receive tailored care. A dedicated educator and mentor, her influence extends globally through collaborative initiatives aimed at enhancing HIV care in resource-limited settings. Her exceptional leadership and approachability have inspired many, making her a true luminary in the DoM and the field of medicine.
Dale
P.S.
Related Posts
DERMATOLOGY Jayden Galamgam, MDPractice Location:Century City Doctor of Medicine:University of Hawaiʻi at Mānoa, John A. Burns School of Medicine Residency:Harbor-UCLA Medical Center Michael Kasperkiewicz, MDPractice[...]
Aboulhosn, JamilInes, DonangeloNicholas, SusanneSingh, ArunBardia, AdityaKahn, KatherineNobakht, NiloofarSingh, RajatBell, DouglasKarlamanga, ArunNorris, KeithSingh, RamCallahan, RenaKim, AriePackard, RenéSouvenir, RhondaCasillas, AlejandraKonecny, GottfriedParikh, RushiSpellman, PaulChang, LinLabus, JenniferPietras, RichardSternini, CatiaChew,[...]
CARDIOLOGY Sami J. Natour, MD Doctor of Medicine:University of Virginia School of Medicine Residency:University of California, Los Angeles Fellowship:University of California, Los Angeles Saate Saiyara[...]