# Individualizing Anticoagulant use in Older Adults with Atrial Fibrillation

> **NIH NIH K76** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $243,000

## Abstract

Project Summary/Abstract
 This is a Beeson (K76) career development award for Sachin J Shah, MD, MPH, a physician-investigator
trained in internal medicine, clinical epidemiology, and aging research. Dr. Shah is an Assistant Professor in
the Division of Hospital Medicine at the University of California, San Francisco. Dr. Shah's long-term goal is to
build evidence to individualize treatment recommendations for older adults facing high-risk, high-benefit
therapeutic decisions using new epidemiologic methods and geriatric research principles. The decision to use
anticoagulants in older adults with atrial fibrillation (AF) is the paradigm of a high-stakes therapeutic decision
because while anticoagulants prevent stroke, they increase the risk of bleeding complications. Guidelines use
a one-size-fits-all approach; for older adults, they recommend near-universal anticoagulant use. In numerous
studies of clinical practice, physicians report concern with the current approach voicing the need to
individualize treatment recommendations for older adults. This proposal addresses the pressing need to
individualize anticoagulant treatment decisions in older adults with AF through two aims. Aim 1: Develop and
validate individualized estimates of the treatment effect of anticoagulants for ischemic stroke prevention in
older adults with AF. This aim will use clinical trial and observational data to develop and validate a treatment
effect model that will estimate individual-level treatment benefit. Aim 2: Ascertain functional outcomes after
major extracranial hemorrhage, both short-term and longer-term. The functional outcomes following major
hemorrhage, a key adverse event of anticoagulant therapy, are unclear, especially in older adults. Through two
studies, this proposal will determine the short- and long-term functional outcomes following major hemorrhage.
 Dr. Shah's exceptional, multidisciplinary mentoring team is led by Dr. Margaret Fang, nationally recognized
for her work studying the clinical outcomes of anticoagulants in older adults and co-mentored by Dr. Kenneth
Covinsky, whose nationally recognized research program has advanced our understanding of the predictors
and outcomes of disability in older adults. This career development award will support Dr. Shah's transition to
research independence through mentorship and focused training in (1) measuring heterogeneous treatment
effects using novel epidemiologic tools, (2) primary data collection to build prospective cohorts of older adults,
(3) designing decision aids and (4) leadership development to lead cross-disciplinary, multi-institutional
research teams. This proposal will support a development grant to design and pilot a clinical decision tool for
older adults considering anticoagulant and a project grant to measure heterogeneous treatment effects of
procedural interventions in older adults with AF. The proposed research and training aims will provide Dr. Shah
with the data, training, and experie...

## Key facts

- **NIH application ID:** 10917131
- **Project number:** 5K76AG074919-04
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Sachin J Shah
- **Activity code:** K76 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $243,000
- **Award type:** 5
- **Project period:** 2021-09-30 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10917131

## Citation

> US National Institutes of Health, RePORTER application 10917131, Individualizing Anticoagulant use in Older Adults with Atrial Fibrillation (5K76AG074919-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10917131. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*