Smith Center Faculty discussing research notesAs exciting advances are made in the world of medicine and new therapies become available to treat cardiovascular diseases, there is an increasing need to validate their safety and maximize their benefit for patients. The Smith Center’s mission is to apply the highest standard of scientific evaluation to essential questions in cardiovascular medicine. We combine novel analytical approaches with deep clinical expertise to understand and improve patient outcomes and advance healthcare delivery.

The Smith Center works within three main areas of focus:

  1. Assessing real-world comparative effectiveness of treatment strategies, medications and devices;   
  2. Evaluating ethical concerns in medicine as well as the intended and unintended consequences of health policy interventions;   
  3. Assessing the ability of novel sources of data (i.e. “Big Data”) to improve risk stratification of patient illness and enhance personalized approaches to medical care.

The projects listed below are a sample of our current research.

Comparative Effectiveness Research

Modern medicine has given rise to an abundance of different ways to treat chronic diseases, and as such, it is increasingly important to understand how these treatment strategies compare to one another in order to maximize efficacy and safety.

Health Policy and Ethics

A key area of focus at the Smith Center is ethical issues relating to medical practice. Our current research is examining topics that include medical decision-making, device implantation and removal, and end-of-life issues, and extends to include the impact of government policy on patient care.

  • Public Reporting of PCI Outcomes
    Several states have implemented policies in recent years that mandate public reporting of patient outcomes for certain procedures, including percutaneous coronary intervention. The Smith Center is researching the impact of these policies on practitioner risk avoidance and subsequent effects on patient outcomes. A recent study led by Dr. Rishi Wadhera suggested that policy efforts to reduce inappropriate use of percutaneous coronary intervention (PCI) procedures may have inadvertently led physicians to change their coding practices.

    Wadhera RK, Sukul D, Secemsky EA, Shen C, Gurm HS, Boden WE, Yeh RW. Temporal Trends in Unstable Angina Diagnosis Codes for Outpatient Percutaneous Coronary Interventions. JAMA Internal Medicine. Published online December 17, 2018.

Personalized Medicine

The Smith Center aims to examine novel sources of data, and to analyze existing data in new ways that support personalized approaches that account for the diversity of patient responses to treatment.

  • Identification of Heterogeneous Treatment

    Because patients differ from one another in their responses to treatment, identifying those patients who have the greatest opportunity to benefit as well as those with the least to gain from medical interventions is essential for high quality, cost-effective, patient-centered care. Smith Center investigators have a number of projects devoted to understanding heterogeneous treatment effects across a broad spectrum of cardiovascular conditions. In particular, the team is working on a large NIH R01-funded study with a consortium of investigators to validate the use of real world claims and registry data in the evaluation of medical therapies in representative populations.