Olamide Alabi receives NHLBI and HSRC pilot grants
NOVEMBER 2020
Olamide Alabi, MD, assistant professor of surgery in the Division of Vascular Surgery and Endovascular Therapy, will apply two recently received pilot grants, one intramural and the other extramural, to investigate issues associated with peripheral artery disease (PAD).
Dr. Alabi was a participant in an intensive workshop for early career investigators at the Program to Increase Diversity in Cardiovascular Health-Related Research (PRIDE-CVD) at the State University of New York (SUNY) Downstate Medical Center, a program funded by the National Heart, Lung, and Blood Institute (NHLBI). After a competitive process, she received funding for her proposal to study disparities in access and treatment for PAD among veterans.
PAD affects over 10 million individuals nationwide and contributes to approximately 185,000 major lower extremity amputations per year. Black patients with PAD are two-to-four times more likely to experience major amputation than white patients, and major amputation rates are higher in the southern United States.
"As the largest integrated healthcare system in the nation, the Veterans Health Administration (VHA) is well-positioned to deliver high quality, equitable care to all veterans," says Dr. Alabi. "However, the literature suggests that even among veterans, Black race is independently associated with amputation related to PAD, though the risk factors that drive this are still undetermined. Given that race is likely a surrogate for place and/or access, an evaluation of social and geographic determinants may yield important information for targeting novel interventions."
With the overarching goal of reducing potentially preventable lower extremity major amputation in veterans with PAD, the central hypothesis of Dr. Alabi's study is that geographic variations in care delivery — such as the volume of diagnostic and/or therapeutic arterial procedures completed for veterans with PAD in the year prior to major amputation — as well as access to specialty care may be factors driving this disparity.
In collaboration with biostatistician Xiangqin Cui, PhD, founding director of the VA Data Analytics Core, Dr. Alabi will review all veterans with PAD who underwent nontraumatic major amputation within the VHA from March 2010 through February 2020. Dr. Alabi hopes to define any differences between national and regional practices related to pre-amputation therapies, as well as the association of race and geographic location with the frequency and availability of these therapies before amputation.
"Understanding the access and treatment variations that veterans with PAD experience could help improve outcomes in this vulnerable population," she says.
Dr. Alabi is also the initiatory recipient of the Emory Health Services Research Center's (HSRC) first cycle of pilot awards. With co-investigators Jessica Harding, PhD, Yazan Duwayri, MD, and Luke Brewster, MD, PhD, Dr. Alabi will examine 90-day outcomes following lower extremity revascularization (LER) for PAD using unique data from a Vascular Quality Initiative-linked Medicare database. This is the first grant awarded to support analysis of this new dataset that links a large vascular procedural registry to Medicare claims.
The study's goal is to estimate 90-day readmission and reintervention rates and identify risk factors associated with poor 90-day outcomes following LER for key subgroups of PAD patients. Dr. Alabi and her team posit that their findings could improve the design and development of future interventions for PAD, and influence the general incorporation of 90-day outcomes as a quality metric and cost analysis tool for LER in high-risk populations.