Atrial Fibrillation Initiative (AF ARC)
INITIATION DATE:
12.01.09
ARC DIRECTORS AND CO-DIRECTORS:
OVERVIEW OF GOALS AND MISSION:
Abstract
The Atrial Fibrillation (AF) Initiative convenes a diverse, complementary array of investigators to collaborate on AF research spanning basic science to global health. AF’s current estimated U.S. prevalence is 2.5 million, and is expected to increase to 12-15 million by 2050. AF’s sequelae include increased risk of mortality, heart failure, stroke, and dementia.
At present multiple investigators at Boston University School of Medicine (BUSM) examine AF in studies ranging from bedside experimentation to international investigations. The AF Initiative’s overall objective consists in fostering collaboration between these individuals to generate interdisciplinary hypotheses and catalyze mutually enhanced investigations into the biochemistry, pathophysiology, epidemiology, genetics and clinical outcomes associated with AF.
ARC Members:
| Name/Title | Dept/School | Role in ARC |
| Emelia J. Benjamin, MD, ScM | Cardiology, DOM, BUSM | Co-Director, investigator |
| Jared W. Magnani, MD | Medicine, BUSM | Co-Director, investigator |
| Caroline M. Apovian, MD | Medicine, Endocrinology, BUSM | Investigator |
| Elaine M. Hylek, MD, MPH | Medicine, General Internal Medicine, BUSM | Investigator |
| Martin G. Larson, ScD | Mathematics and Consulting Unit, FHS, BU | Statistician |
| David R. Pimental, MD | Whitaker Cardiovascular Institute, BUSM | Investigator |
| Robert S. Poston, MD | Cardiothoracic surgery | Investigator |
| Frederick L. Ruberg, MD | Medicine, Radiology | Investigator |
| Nancy J. Kressin, PhD | Medicine, BU Health Care Disparities Unit, BUSM | Visitor |
| Kathryn L. Lunetta, PhD | Department of Biostatistics, BUSPH | Visitor |
| Michael J. Mazzini, MD | Whitaker Cardiovascular Institute, BUSM | Visitor |
| Michael J. Pencina, PhD | Department of Biostatistics, BUSPH | Visitor |
| Avrum Spira, MD | Director, Translational Bioinformatics Core, Clinical and Translational Scientific Institute, BU | Visitor |
| Lisa M. Sullivan, PhD | Chair, Department of Biostatistics, BUSPH | Visitor |
| Alvaro Alonso, MD, PhD | School of Public Health, University of MN | Visitor |
| Lesley H. Curtis, PhD | Duke Clinical Research Institute, Duke | Visitor |
| Patrick T. Ellinor, MD, PhD | Medicine (electrophysiology), MGH, Harvard | Visitor |
| Susan R. Heckbert, MD, PhD | University of WA, School of Public Health | Visitor |
MAIN ARC PROJECT(S) FOR 2009-2010:
- Anticoagulation and AF: risk of stroke and epidemiology of anticoagulation. Anticoagulation’s critical role in AF is underscored by the condition’s increased risks of dementia and stroke.8, 16-18 Dr. Elaine Hylek within General Internal Medicine at BUSM has an international reputation and involvement on anticoagulation practice, hazards, novel anticoagulants and their role in stroke prevention in AF. At BUSM she is investigating variability in the international normalized ratio (INR), the clinical marker for therapeutic anticoagulation, and its relation to factors mediating underlying inflammation (e.g. diabetes, hypertension). BUSM provides a venue for assessing the clinical, social and racial/ethnic factors associated with INR variability, risk for lack of therapeutic efficacy, and AF outcomes. Dr. Hylek’s active collaboration with Dr. Nancy Kressin of the Center for Health Qaulity, Outcomes, and Economic Research will elucidate disparities in AF care within our institution.
- Amyloidosis. Dr. Frederic Ruberg, Cardiology Division, participates in the Amyloidosis Center at Boston Medical Center. Cardiac amyloidosis impacts atrial function and tissue, frequently yielding AF. Little is known about predicting AF risk in individuals with cardiac amyloidosis or the impact of AF on mortality. BUSM is a unique resource for conducting such an investigation because of the meticulous data kept by the Amyloid Center and its role as an internationally recognized clinical site for treatment and investigation.
- P wave morphology; clinical risk in a diverse patient setting. P wave indices are altered by multiple cardiovascular and non-cardiovascular disease states and have been reported to be associated with increased AF risk in largely white patient samples. The AF Initiative will bring measurement of P wave indices to BUMC, and will facilitate and provide an avenue for examining the distribution of P wave indices by race, presence of obesity (Apovian), cardiac amyloidosis (Ruberg), and post-operative status (Poston).
- Novel risk factors for AF. AF Initiative investigators have strategic alliances with clinicians involved in vulnerable and unique cohorts. Anthropometric risk factors (e.g. body mass index) have shown direct, positive correlation with AF risk. Dr. Carol Apovian within the Endocrinology Division brings expertise in the relation of obesity to cardiovascular outcomes. Her collaboration will facilitate investigating the interrelation of obesity and AF to mortality. Furthermore, Boston Medical Center has a high proportion of ethnic minorities. The AF Initiative will examine the relation of race in all investigations to elucidate its relation with AF risk.
- Epidemiology and genetics of P wave indices and PR interval in the community. Drs. Jared W. Magnani and Benjamin, Cardiology Division, DOM, have investigated P wave indices in the Framingham Heart Study (FHS). P wave indices are intermediate phenotypes for AF reflecting interatrial conduction. These investigators have initiated a unique database of more sophisticated P wave indices within FHS, demonstrated measurement reliability, and are prospectively examining the relation of P wave indices to AF risk.
ARC AS A RESOURCE:
The AF Initiative ARC is an opportunity to enhance interdisciplinary and translational collaborative approaches to catalyze new discoveries of the pathophysiology, risk factors, genetics, prognosis and outcomes of AF by uniting investigators examining AF. Members of the ARC AF Initiative have expertise in cellular electrophysiology, epidemiology, genetics, outcomes research, biostatistics and systems biology. There are opportunities for investigators to collaborate between multiple components of the initiative, or to assemble resources for more expansive partnership. The ARC will facilitate novel, cross-disciplinary research, generate pilot data and markedly enhance the likelihood of securing additional NIH grant support for investigators at all career levels.
A core objective is to provide a forum for AF translational collaborations catalyzing research productivity and funding opportunities, and to support senior and peer mentorship to early investigators, facilitating transition to independence.