Andrew P Ambrosy, MD

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

(510) 891-3607 (phone)
andrew.p.ambrosy@kp.org

Andrew P. Ambrosy, MD, is a practicing non-invasive cardiologist at Kaiser Permanente San Francisco Medical Center and a clinician-investigator at Kaiser Permanente Northern California (KPNC) Division of Research. Dr. Ambrosy has research interests in cardiovascular and metabolic conditions, with a particular focus on ischemic heart disease and heart failure. He also has methodological expertise in generating real-world evidence through health services, implementation science, and pragmatic clinical trials. He is the KPNC Regional Assistant Medical Director of the Clinical Trials Program and supports site-based research for all therapeutic areas across 21 medical centers and more than 260 clinics. He is the recipient of a National Heart, Lung, and Blood Institute (NHLBI)-funded Mentored Patient-Oriented Research Career Development Award (K23HL150159) focused on identifying and characterizing outpatient worsening heart failure within an integrated and learning health care system. He is currently the Principal Investigator (PI), Co-PI, or Co-Investigator on multiple investigator-initiated and industry-sponsored traditional and pragmatic clinical trials addressing a broad range of medical topics. Dr. Ambrosy previously completed a 2-year dedicated research fellowship at the Duke Clinical Research Institute, gaining hands-on experience in all aspects of clinical trial operations. This includes study design, site activation, recruitment/enrollment, and data and safety monitoring. He is an Associate Editor for the American Heart Journal and serves on the editorial boards for European Journal of Heart Failure and Journal of Cardiac Failure. Dr. Ambrosy has presented his research at national and international scientific meetings and authored more than 150 peer-reviewed manuscripts.

Current Position(s):

Staff Cardiologist, Department of Cardiology, The Permanente Medical Group, San Francisco
Research Scientist, Division of Research, Kaiser Permanente Northern California
Associate Program Director for Research (Fellowship), Department of Cardiology, The Permanente Medical Group, San Francisco
Assistant Medical Director, Clinical Trials Program, Kaiser Permanente Northern California

Section Affiliations:

Cardiovascular and Metabolic Conditions

Primary Research Interests:

Ischemia Heart Disease
Cardiomyopathy
Heart Failure
Health Outcomes
Implementation Science
Clinical Trials

Related Website(s):

Clinical Trials Program (CTP)

Studies

Improving Care by Defining the Role of ElectroNic HealTh Record-Based Alerts In a Fully Integrated Health Care Delivery SYstem for Worsening Heart Failure (IDENTIFY-WHF)

IDENTIFY-WHF is a prospective, virtual, parallel-group, randomized, quality improvement intervention of EHR-based alerts for worsening heart failure (WHF) to improve the adoption of guideline-directed medical therapy (GDMT) within an integrated and learning health care delivery system. Approximately 1,000 participants will be randomized 1:1 to the intervention or usual standard of care. The primary outcome is the proportion of adults experiencing WHF with an increase in the number of prescribed GDMT classes at 30 days post-discharge from the hospital or ED.
Investigator: Ambrosy, Andrew
Funder: TPMG Delivery Science Projects Program

Trajectory of PRimary and SEcondAry HospitalizaTions for Worsening Heart Failure (TREAT-WHF)

The primary objective of the TREAT-WHF study is to leverage a diverse and contemporary heart failure cohort with rigorously adjudicated worsening heart failure events to describe the crude rate of all-cause and cause-specific health care utilization and the independent association of secondary heart failure hospitalizations with outcomes after adjusting for traditional risk factors. This study builds on our prior research that showed machine learning-based natural language processing algorithms can accurately identify hospitalizations for worsening heart failure and resulted in a more than twofold increase in the perceived population burden of hospitalizations for worsening heart failure compared to diagnostic coding alone.
Investigator: Ambrosy, Andrew
Funder: Lexicon Pharmaceuticals, Inc.

Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen in Acute Coronary Syndrome (CLEAR ACS) Study

The overall objective of the Cholesterol Lowering via Bempedoic Acid/Ezetimibe, an ACL-Inhibiting Regimen in Acute Coronary Syndrome ACS (CLEAR ACS) study is to determine the efficacy, safety, and tolerability of bempedoic acid/ezetimibe (BA/E) in a contemporary and real-world population, enriched for older adults, women, and underrepresented racial/ethnic groups, of adults with a recent acute coronary syndrome (ACS) event independent of use of statin therapy before the ACS event. CLEAR ACS study is a prospective, virtual, electronic health record (EHR)-based, randomized, double-blind, placebo-controlled, parallel-group, pragmatic clinical trial embedded within Kaiser Permanente Northern California's fully integrated and learning health care delivery system.
Investigator: Ambrosy, Andrew
Funder: Esperion Therapeutics, Inc.

Clinical Characteristics and Outcomes of Patients with Asymptomatic, Moderate Severity Aortic Stenosis (ASSESS-AS)

The prevalence of aortic stenosis (AS), currently estimated to be 4% among adults 70 years of age and over is projected to double by 2040 and triple by 2060. However, the prevalence, clinical characteristics, and outcomes of the condition have not been well-characterized in a contemporary, demographically diverse cohort with asymptomatic moderate AS. We are leveraging a natural language processing (NLP)-based approach applied to state-of-the-art electronic health record semi-structured data to describe (1) the prevalence and clinical characteristics, (2) all-cause and cause-specific healthcare utilization and all-cause death, and (3) independent clinical predictors of all-cause and cause-specific morbidity and mortality among a diverse real-world cohort of asymptomatic adults with moderate AS.
Investigator: Ambrosy, Andrew
Funder: Edwards Lifesciences LLC

GUARD-AF: reducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals

To determine if one-time screening for atrial fibrillation using the 14-day Zio XT patch leads to a reduced risk of stroke compared with usual care among adults aged 70 years or older without prior known atrial fibrillation or atrial flutter.
Investigator: Go, Alan; Ambrosy, Andrew
Funder: Bristol-Myers Squibb Company

The Use of Natural Language Processing to Characterize Episodes of Outpatient Worsening Heart Failure within an Integrated Health Care Delivery System

This study will assess the accuracy of using a natural language processing-based approach to retrospectively identify episodes of outpatient worsening heart failure in unstructured electronic health record data within an integrated health care delivery system and assess the burden and clinical characteristics of these outpatients.
Investigator: Ambrosy, Andrew
Funder: Northern California Community Benefit Programs

A Multicenter, Randomized, Placebo-controlled Pragmatic Phase 3 Study Investigating the Efficacy and Safety of Rivaroxaban to Reduce the Risk of Major Venous and Arterial Thrombotic Events in Medically Ill Outpatients with Acute Symptomatic COVID-19 (PRE

This virtual, pragmatic randomized clinical trial will evaluate whether rivaroxaban reduces the risk of a composite endpoint of major venous and arterial thrombotic events, all-cause hospitalization, and all-cause mortality compared with placebo in outpatients with acute, symptomatic COVID-19 infection.
Investigator: Go, Alan; Ambrosy, Andrew
Funder: Janssen AIzheimer Immunotherapy R＆D

Outpatient Worsening Heart Failure in an Integrated Health Care Delivery System: An Innovative Approach to Characterizing a Novel Clinical Entity

While the Affordable Care Act-mandated Hospital Readmission Reduction Program launched in 2012 has modestly reduced readmissions, an unintended consequence has been the shift of a significant fraction of heart failure (HF)-related care to the outpatient setting. However, little is known about the epidemiology, clinical profile, treatment patterns, and/or outcomes of outpatient worsening HF (WHF). To address these critical knowledge gaps, we propose (1) to systematically describe the contemporary epidemiology, clinical characteristics, treatment patterns, and outcomes associated with outpatient WHF and (2) to evaluate the impact of an episode of outpatient WHF on generic and disease-specific HRQOL in the context of a fully integrated health care delivery system.
Investigator: Ambrosy, Andrew
Funder: National Heart, Lung, and Blood Institute

KP NOURISH: Evaluation of the Clinical Utility of Medically-Tailored Meals in Adults with Chronic Conditions

This pragmatic randomized clinical trial funded through National and NCAL Community Health/Benefits is testing the impact of medically-tailored meals and enhanced nutritional counseling compared to usual care on clinical and patient-centered outcomes in hospitalized adults with targeted medical conditions being discharged home from KP Santa Rosa or Santa Clara Medical Centers.
Investigator: Go, Alan; Ambrosy, Andrew
Funder: Kaiser Permanente Program Offices

A Multi-center, Multi-country Retrospective Cohort Study to Evaluate the Clinical Outcomes in Adults with Severe COVID-19

This multi-center, multi-country retrospective cohort study will assess the clinical course and outcome of adults with severe COVID-19 not treated with remdesivir using a 7-point ordinal scale for clinical outcomes on Day 14 and all-cause mortality at Day 28 after admission. This study complements ongoing clinical trials of remdesivir for the treatment of severe COVID-19 infection.
Investigator: Go, Alan; Ambrosy, Andrew
Funder: Gilead Sciences, Inc.

Transcatheter Mitral-Valve Repair in Patients with Heart Failure and Functional Mitral Regurgitation - Potential Scope and Clinical Benefit of Early Adoption at an Integrated Healthcare Delivery System

This study will look at the clinical benefit of early adoption of the MitraClip device in patients with heart failure in a real-world setting. Previous research showed patients who have the MitraClip procedure have 50% fewer hospitalizations for heart failure within the next 24 months than those who receive the standard of care. The MitraClip is used to reduce mitral regurgitation, a common side effect of heart failure, that affects quality of life and functioning, increases risk of hospitalization, and reduces survival despite medical therapy.
Investigator: Ambrosy, Andrew
Funder: Abbott Laboratories

Evaluating Inpatient and OutpatIent Encounters Within a Learning and Integrated Health Care Delivery Organization Due to Worsening Heart Failure (UTILIZE-WHF)

This study will assess the inpatient and outpatient health care utilization and mortality of patients with heart failure and how it relates to their degree of systolic dysfunction.
Investigator: Ambrosy, Andrew
Funder: Novartis International AG

Pragmatic RandomIzed Trial of Icosapent Ethyl for High-Cadiovascular Risk Adults (MITIGATE)

The MITIGATE Study will evaluate the real-world clinical effectiveness of icosapent ethyl (Vascepa®) compared to usual care in patients with established atherosclerotic cardiovascular disease. The study will evaluate whether the drug, which is used to reduce the risk of heart disease and stroke, can also prevent or reduce the risk of complications from viral respiratory illnesses in older adults with heart disease.
Investigator: Ambrosy, Andrew
Funder: Amarin Corporation

Healthy Eating as a Means for Active Living in Heart Failure (HEAL-HF) Study

There is an unmet clinical need to better understand the impact of lifestyle choices with respect to diet and nutrition in high-risk heart failure patients who have been recently hospitalized. We will conduct a survey-based project using a combination of questionnaires to assess 4 clinically relevant domains: food access and security, dietary composition and quality, nutritional awareness and understanding, and attitudes toward nutrition-related research. The survey itself will take no more than 15 to 30 minutes to complete and will be administered via telephone to 1,000 consecutive patients recently hospitalized with a primary diagnosis of heart failure who are responsible for their own meal planning. In addition to the survey elements, outcomes of interest will include subsequent heart failure hospitalization, all-cause hospitalization, and mortality occurring within 30 days. These outcomes will be passively collected via Kaiser Permanente HealthConnect electronic health records.
Investigator: Go, Alan; Ambrosy, Andrew; Gordon, Nancy
Funder: Northern California Community Benefit Programs

Disparities in Residual Risk in Patients Receiving Statins for Primary or Secondary Prevention at an Integrated Health Care Delivery System

Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for first-time or recurrent nonfatal and fatal events, despite guideline-directed medical therapy for primary and secondary prevention. In fact, even among patients who are appropriately treated with lipid-lowering therapies and have an LDL-C that is at goal and in line with current guideline recommendations, substantial residual risk persists. There is now a considerable body of evidence to suggest that plasma triglycerides contribute to residual risk and play a causal role in atherogenesis and ASCVD risk. Furthermore, older adults, women, and nonwhite participants may have a disproportionately different prevalence of elevated triglyceride levels and be at incrementally greater risk of recurrent ASCVD events. Given the public health implications, it is important to better understand the extent of age-, gender-, and ethnicity/race-related disparities in residual risk.
Investigator: Ambrosy, Andrew
Funder: Amarin Corporation

TRANSFORM-HF (ToRsemide compArisoN with furoSemide FOR Management of Heart Failure) Study

Patients with heart failure will be randomized 1:1 to either oral torsemide or oral furosemide prior to hospital discharge. The primary endpoint will be all-cause mortality over the follow-up period. Secondary endpoints are hospitalizations, quality of life, and depression.
Investigator: Ambrosy, Andrew
Funder: National Heart, Lung, and Blood Institute

Partnership for Anemia: Clinical and Translational Trials in the Elderly (PACTTE)

Within the CVRN-HF Network, and in collaboration with NIA-sponsored PACTTE consortium investigators, we will examine the following among a large, multi-center cohort of elderly patients with heart failure with reduced or preserved left ventricular systolic function: 1) to characterize the contemporary frequency of testing for and prevalence of anemia; 2) to assess the frequency, timing and extent of evaluation for reversible causes of anemia in those with documented anemia; 3) to evaluate contemporary adverse event rates by hemoglobin level; and 4) to examine the feasibility of conducting a potential pragmatic clinical trial of systematic evaluation of anemia in elderly heart failure patients.
Investigator: Go, Alan; Ambrosy, Andrew
Funder: National Institute on Aging

Highlighted Publications

A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System

Author(s): Ambrosy, Andrew P; Go, Alan S; et al.

JAMA Netw Open. 2021 11 01;4(11):e2135152. Epub 2021-11-01.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Related Website(s):

Studies

Improving Care by Defining the Role of ElectroNic HealTh Record-Based Alerts In a Fully Integrated Health Care Delivery SYstem for Worsening Heart Failure (IDENTIFY-WHF)

Trajectory of PRimary and SEcondAry HospitalizaTions for Worsening Heart Failure (TREAT-WHF)

Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen in Acute Coronary Syndrome (CLEAR ACS) Study

Clinical Characteristics and Outcomes of Patients with Asymptomatic, Moderate Severity Aortic Stenosis (ASSESS-AS)

GUARD-AF: reducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals

The Use of Natural Language Processing to Characterize Episodes of Outpatient Worsening Heart Failure within an Integrated Health Care Delivery System

A Multicenter, Randomized, Placebo-controlled Pragmatic Phase 3 Study Investigating the Efficacy and Safety of Rivaroxaban to Reduce the Risk of Major Venous and Arterial Thrombotic Events in Medically Ill Outpatients with Acute Symptomatic COVID-19 (PRE

Outpatient Worsening Heart Failure in an Integrated Health Care Delivery System: An Innovative Approach to Characterizing a Novel Clinical Entity

KP NOURISH: Evaluation of the Clinical Utility of Medically-Tailored Meals in Adults with Chronic Conditions

A Multi-center, Multi-country Retrospective Cohort Study to Evaluate the Clinical Outcomes in Adults with Severe COVID-19

Transcatheter Mitral-Valve Repair in Patients with Heart Failure and Functional Mitral Regurgitation - Potential Scope and Clinical Benefit of Early Adoption at an Integrated Healthcare Delivery System

Evaluating Inpatient and OutpatIent Encounters Within a Learning and Integrated Health Care Delivery Organization Due to Worsening Heart Failure (UTILIZE-WHF)

Pragmatic RandomIzed Trial of Icosapent Ethyl for High-Cadiovascular Risk Adults (MITIGATE)

Healthy Eating as a Means for Active Living in Heart Failure (HEAL-HF) Study

Disparities in Residual Risk in Patients Receiving Statins for Primary or Secondary Prevention at an Integrated Health Care Delivery System

TRANSFORM-HF (ToRsemide compArisoN with furoSemide FOR Management of Heart Failure) Study

Partnership for Anemia: Clinical and Translational Trials in the Elderly (PACTTE)

Highlighted Publications

A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System

Publications

Temporal trends in the prevalence and severity of aortic stenosis within a contemporary and diverse community-based cohort

Polypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure: The GUIDE-IT Trial

Association Between Serum Albumin and Outcomes in Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial

Intravenous iron infusion in patients with heart failure: a systematic review and study-level meta-analysis

Predictors of Incident Heart Failure Diagnosis Setting: Insights From the Veterans Affairs Healthcare System

Predicting Short-term Outcomes After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas

Characteristics and Outcomes of Suspected Digoxin Toxicity and Immune Fab Treatment Over the Past Two Decades-2000-2020

Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults

Fluid Restriction Recommendations in Heart Failure Dry as a Bone or Quench Your Thirst?

Variation in Heart Failure Risk by HIV Severity and Sex in People With HIV Infection

Heart Failure with Iron Deficiency across the Left Ventricular Ejection Fraction Continuum - Need to Redefine?

Analysis of Worsening Heart Failure Events in an Integrated Health Care System

Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician

Prognostic Value of Echocardiography for Heart Failure and Death in Adults with Chronic Kidney Disease

A Randomized Controlled Trial of Renin-Angiotensin-Aldosterone System Inhibitor Management in Patients Admitted in Hospital with COVID-19

Trends and characteristics of hospitalizations for heart failure in the United States from 2004 to 2018

Global assessment improves risk stratification for major adverse cardiac events across a wide range of triglyceride levels: Insights from the KP REACH study

A Machine Learning Methodology for Identification and Triage of Heart Failure Exacerbations

Food security, diet quality, nutritional knowledge, and attitudes towards research in adults with heart failure during the COVID-19 pandemic

Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study

Trends in Hospitalizations for Heart Failure, Acute Myocardial Infarction, and Stroke in the United States from 2004-2018

Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

A Natural Language Processing-Based Approach for Identifying Hospitalizations for Worsening Heart Failure Within an Integrated Health Care Delivery System

Human immunodeficiency virus infection and risks of morbidity and death in adults with incident heart failure

Triglyceride Levels and Residual Risk of Atherosclerotic Cardiovascular Disease Events and Death in Adults Receiving Statin Therapy for Primary or Secondary Prevention: Insights From the KP REACH Study

Timing of AKI after urgent percutaneous coronary intervention and clinical outcomes: a high-dimensional propensity score analysis

Implications of the Landmark ISCHEMIA Trial on the Initial Management of High-Risk Patients with Stable Ischemic Heart Disease

A Randomized Trial of Icosapent Ethyl in Ambulatory Patients with COVID-19

Growth differentiation factor-15, treatment with liraglutide, and clinical outcomes among patients with heart failure

Safety and Efficacy of Intravenous Ferric Derisomaltose Compared to Iron Sucrose for Iron Deficiency Anemia in Patients with Chronic Kidney Disease With and Without Heart Failure

Pregnancy-Associated Spontaneous Coronary Artery Dissection: Clinical Characteristics, Outcomes, and Risk During Subsequent Pregnancy

Making The Case For Sacubitril/Valsartan In Patients With Heart Failure With A Preserved Ejection Fraction

Rationale and Design of the Pragmatic Randomized Trial of Icosapent Ethyl for High Cardiovascular Risk Adults (MITIGATE)

Randomized Placebo-Controlled Trial of Ferric Carboxymaltose in Heart Failure With Iron Deficiency: Rationale and Design

Improving adherence to guideline-directed medical therapies and outcomes in the developing world: A call to end global inequities in heart failure

Temporal trends in the outcomes of acute heart failure: between consolatory evidences and real progress

Management of Renin-Angiotensin-Aldosterone System blockade in patients admitted to hospital with confirmed coronavirus disease (COVID-19) infection (The McGill RAAS-COVID- 19): A structured summary of a study protocol for a randomized controlled trial

Implications of peripheral oedema in heart failure with preserved ejection fraction: a heart failure network analysis

Loop Diuretic Use and Outcomes in Chronic Stable Heart Failure With Preserved Ejection Fraction-Reply

The Degree of the Predischarge Pulmonary Congestion in Patients Hospitalized for Worsening Heart Failure Predicts Readmission and Mortality

Hospitalizations for Heart Failure and Mortality Risk During the Evolving Coronavirus Disease 2019 Pandemic - The Wave May Break but A Dangerous Undertow Persists

Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation

Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction: Rationale and Design of the LIFE Trial

Hospitalizations for heart failure during the COVID-19 pandemic: making sense of the known knowns, known unknowns, and unknown unknowns

Angiotensin-Neprilysin Inhibition in Black Americans: Data From the PIONEER-HF Trial

Improving Physical Activity and Exercise Capacity in Heart Failure Taking the First Step is Always the Hardest

Angiotensin Receptor-Neprilysin Inhibition Based on History of Heart Failure and Use of Renin-Angiotensin System Antagonists

The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction

Association between systolic ejection time and outcomes in heart failure by ejection fraction

A reduced transferrin saturation is independently associated with excess morbidity and mortality in older adults with heart failure and incident anemia

Periprocedural Risk and Survival Associated With Implantable Cardioverter-Defibrillator Placement in Older Patients With Advanced Heart Failure

One-year mortality after implantable cardioverter-defibrillator placement within the Veterans Affairs Health System

Effects of Liraglutide on Worsening Renal Function Among Patients With Heart Failure With Reduced Ejection Fraction: Insights From the FIGHT Trial

Spontaneous Coronary Artery Dissection and Incident Ventricular Arrhythmias: Frequency, Clinical Characteristics, and Outcomes