Current Projects

As 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. A major focus of the research at the Smith Center is to evaluate the effectiveness, benefits, and potential harms of different cardiovascular treatments and technologies.

• Use of Instrumental Variable Methods to Compare Treatment Strategies to Reduce Bleeding in Percutaneous Coronary Intervention (PCI)
  Observational comparisons of treatment approaches can be challenging due to methodological limitations of commonly used approaches. We have conducted analyses that leverage novel analytical approaches including instrumental variable methods and falsification endpoints to improve the reliability of such comparisons. These have included evaluations of vascular access closure devices and anticoagulants such as bivalirudin in patients undergoing angioplasty procedures.

• Anticoagulant Use and PCI
  As new medications enter the market, prescribing patterns for these medications change over time. Researchers at the Smith Center are interested in evaluating these trends and how they affect patients undergoing cardiac procedures such as percutaneous coronary intervention (PCI).

• Cost-Effectiveness of Novel Stent Platforms
  Smith Center investigators are conducting decision analytic models to evaluate whether and under what conditions new stent platforms can be considered cost effective compared to current generations of stents.

• Measurement of Patient-Reported Outcomes
  We are developing innovative ways to measure patient-reported outcomes in the routine course of clinical care in order to evaluate the effectiveness of interventions primarily meant to improve patient symptoms. These interventions include chronic total occlusion angioplasty and ablation for atrial fibrillation.

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.

• Healthcare Reform
  The implementation of the Affordable Care Act brought changes to the way hospitals are reimbursed by Medicare and Medicaid, such that hospitals are financially penalized for having high readmission rates. Researchers at the Smith Center are using large national datasets to investigate the impact of this policy on hospital performance and patient outcomes.

• Medical Device Regulation and Surveillance
  A growing number of implantable devices, such as pacemakers and implantable cardioverter defibrillators (ICDs) now contain remote monitoring systems that connect patients to clinicians and manufacturers. In addition, large registries of patients with ICDs and other high-risk implanted devices are being organized to more quickly identify emerging safety issues, such as device malfunctions. However, intensive collection of personal data through continuous remote monitoring and device registries implicates patients’ privacy interests, may not involve meaningful informed consent, and can alter patient-physician relationships. Using ICDs as a model and utilizing a variety of qualitative research methods, Smith Center researchers seek to define and evaluate the ethical challenges related to information sharing and digital connectivity.

• 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.

• Environmental Pollution and Prognosis following Cardiovascular Events
  Levels of ambient pollution have been associated with cardiovascular and cerebrovascular events, even at relatively low levels of exposure. Researchers at the Smith Center are investigating how air pollution is related to prognosis following cardiovascular events and how measures used in urban planning and policy such as green space and land use may improve outcomes.

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.

• Risk Prediction Modeling and Personalized Medicine

  Researchers at the Smith Center are developing and testing new technologies to predict individual patients’ risk of adverse events after cardiac procedures based on Electronic Health Record data.

• Identification of Heterogeneous Treatment

  Because patients differ from one another in their responses to treatment, identifying those patients who have the greatest 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.