Hartford Outcomes Award Supports Key Research Concerning Warfarin Therapy and Hemorrhage Risk in Older Adults, and Paves Way for Further Research

It was a dilemma, says Margaret C. Fang, MD, MPH, an Assistant Professor of Medicine at the University of California at San Francisco, that led her to the research she's now conducting with the support of a Hartford Geriatrics Health Outcomes Research Scholars Award.

One of four 2005 winners of the award, which is sponsored by the American Geriatrics Society's Foundation for Health in Aging and funded by the John A. Hartford Foundation, Dr. Fang is investigating how best to use anticoagulants in older patients, an issue of critical importance in their care. The two-year Hartford Outcomes award is designed to support physician-scientists committed to improving the care of older adults while they make the critical transition from junior faculty to independent researcher. Over the two years, award winners receive $130,000 in salary and research support.

"Anticoagulants offer a lot of benefits, particularly for people with conditions such as atrial fibrillation, which is very common and potentially very lethal in older people," says Dr. Fang. "But we always worry about giving these drugs to older people because they run the very highest risk of complications from the drugs. So, on one hand, older people are at the highest risk if they don't take these medications and on the other, they are at the highest risk if they do take them. I became interested in how to address this dilemma."

Dr. Fang was awarded a Hartford Outcomes prize to research the use and outcomes of treatment with the anticoagulant warfarin in the treatment of older patients with atrial fibrillation. In older adults, long-term warfarin therapy is most commonly prescribed for this type of cardiac arrhythmia, which is a major cause of stroke in the elderly. While warfarin lowers the risk of ischemic stroke associated with atrial fibrillation it also boosts the risk of major hemorrhage. Among other things, Dr. Fang was interested in comparing risks of brain hemorrhage in older atrial fibrillation patients who were and were not getting warfarin therapy.

"My Hartford Outcomes Award has provided protected time for two years so I can analyze data from a study called the ATRIA Study," explains Dr. Fang, a graduate of Northwestern University School of Medicine who earned her MPH at Harvard School of Public Health.

The ATRIA study is based at the Division of Research at Kaiser Permanente with investigators from the University of California at San Francisco, Massachusetts General Hospital and Boston University School of Medicine. Focusing on a sample of more than 13,000 patients with atrial fibrillation who are part of the study, Dr. Fang and colleagues analyzing the ATRIA data have found that, in these patients, older age boosts the risk of major hemorrhage regardless of whether they receive warfarin therapy. Dr. Fang and her colleagues have also found that the overall likelihood of hemorrhage among those on warfarin is still relatively small. "These findings indicate that well-managed warfarin therapy can be used safely in clinical practice to achieve substantial benefit in reducing the risk of atrial fibrillation-associated ischemic stroke," they reported in the August 10, 2006 issue of the Journal of the American Geriatrics Society. The group will publish further findings on death and disability associated with intracranial hemorrhage this fall.

In addition to affording her time for this research, Dr. Fang adds, the Hartford Outcomes grant has also given her an opportunity to develop ideas for related research and apply for additional grants to fund it.

"The Hartford grant strengthened my application for a Beeson award," says Dr. Fang, who was one of 11 scientists recently awarded a prestigious 2006 Paul B. Beeson Career Development Award in Aging Research. The five-year awards are designed to foster the independent research careers of clinically trained investigators whose work and leadership enhance the health and quality of life of older people in particular. Her award will fully fund her research salary and cover other research expenses for the next five years.

During those five years, Dr. Fang plans to investigate, among other things, the clinical management of older patients taking warfarin and the outcomes in frail elders with atrial fibrillation.

"What I'm doing," she says, "is taking some of the data from the studies I've been able to work on thanks to the Hartford award and use this data as a springboard for subsequent studies."