# Variations in Use of Heart Replacement Therapies Among Patients with Advanced Heart Failure

> **NIH NIH K23** · UNIVERSITY OF COLORADO DENVER · 2021 · $170,536

## Abstract

PROJECT SUMMARY/ ABSTRACT
Heart replacement therapies (i.e., heart transplants and left ventricular assist devices) can improve advanced
heart failure patients’ morbidity, mortality, and quality of life. However, these therapies are associated with both
high risks and potentially high rewards. An advanced heart failure patient’s path to receiving heart replacement
therapies is dependent on 3 critical steps: (1) referral to an advanced heart failure center, (2) clinical evaluation
at the center, and (3) case review by a multidisciplinary selection committee. This pathway is heterogeneous
across the country leading to both underuse and overuse of therapies. There is an urgent need to study where
and why these variations in use exist and to implement solutions that reduce unwarranted variations in care.
The rationale that underlies the proposed research is that if we can understand the factors that lead to
variations in heart replacement therapies at each of the three critical steps, we can develop standardized
processes to ensure that heart failure patients who are most likely to benefit from these therapies have access
to them, and those who are unlikely to qualify can move quickly to other treatment approaches most suited to
their needs and preferences. This career development award includes three complementary aims. Aim 1 will
quantitatively assess the degree of geographic variation at each of the three steps using Medicare claims and
the Dartmouth Atlas hospital referral regions. Aim 2 will qualitatively assess reasons for variation by performing
critical reviews of selection meetings and stakeholder interviews at advanced heart failure centers that are
chosen based on findings from Aim 1. Aim 3 will use Delphi panels to rank factors contributing to unwarranted
variation and propose potential solutions to reduce variation. A deeper understanding of variations in heart
replacement therapy use coupled with expert-vetted proposed solutions for the leading problems will result in a
R01 intervention trial that will address one or more of the modifiable factors and will help reduce unwarranted
variations in use of heart replacement therapies. The applicant, an advanced heart failure cardiologist,
proposes a five-year career development program to complement the research proposal. This incorporates
close mentoring with Drs. Larry Allen (primary), Dan Matlock, and Fred Masoudi, nationally-renowned
cardiovascular outcomes researchers with expertise in advanced heart failure, claims data, qualitative
research, and shared decision-making. The candidate has built productive relationships with her mentors with
four published manuscripts and two in progress and has a supportive institutional environment. To supplement
her prior Masters in Public Health training, the candidate has developed a detailed didactic plan that includes
training in Medicare claims data use, geographic analyses, qualitative methodology, and dissemination and
implementation science. Th...

## Key facts

- **NIH application ID:** 10086995
- **Project number:** 5K23HL145122-03
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Prateeti Khazanie
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $170,536
- **Award type:** 5
- **Project period:** 2019-01-15 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10086995

## Citation

> US National Institutes of Health, RePORTER application 10086995, Variations in Use of Heart Replacement Therapies Among Patients with Advanced Heart Failure (5K23HL145122-03). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10086995. Licensed CC0.

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