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.
Our Work
Validation of Observational Data against Clinical Trials
The timely and efficient evaluation of new medical treatments is critical to improving public health. Vast amounts of data are collected in the course of routine patient care by registries, health systems, and payers. These sources of information could be used to support clinical trial evaluations of novel medical interventions, but require validation. The NIH-funded EXTEND Study is using a combination of trial, claims, and registry data to test several hypotheses central to the future evaluation of cardiovascular therapies.
Rigorous Statistical Methods
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 using state-of-the-art statistical methods. We have pioneered the application of pre-post trends and difference-in-difference analyses, originally used in the economics literature, to the evaluation of health policy outcomes. Findings of these studies have shed new light on the impact of the Hospital Readmissions Reduction Program on readmission rates and on hospitals serving poorer patients, and the impact of state Medicaid expansion on cardiovascular mortality. We have also used instrumental variable analyses to evaluate practice patterns and outcomes associated with medical therapies including bivalirudin use in percutaneous coronary intervention and the use of cardiac resynchronization therapy with and without defibrillator backup.
Identification of Heterogeneous Treatment Effects
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 currently working on the NIH R01-funded EXTEND 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.
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 data from the electronic health record and other administrative data sources. Smith Center researchers have recently published a series of studies which showed that incorporating non-traditional markers of frailty to traditional risk scores can improve the prediction of outcomes such as mortality after transcatheter valve procedures. This work is being expanded by an NIH-funded K24 mentorship grant focused on using claims-based frailty to support individualized treatment of patients with aortic valve stenosis and coronary artery disease.
Patient-Centered Outcomes
Guidelines for cardiovascular care increasingly advocate for shared decision-making between clinicians, patients and family members. Researchers at the Smith Center are studying various aspects of shared decision-making in areas such as cardiac device implantation and peripheral artery disease, evaluating its effectiveness in helping patients and clinicians select therapies that align with the patient’s goals, and identifying obstacles to its implementation in the clinical setting. Smith Center researchers have also championed the use of patient-reported outcome measures for patients with coronary and peripheral artery diseases as an important way to incorporate the patient’s perspective into clinical decision-making and the measurement of outcomes.
Section Head: Dr. Daniel Kramer
The Electrophysiology & Digital Health Section focuses on electrophysiology effectiveness, clinical policy and ethics questions arising from the use of medical devices. Cardiac implantable electrical devices (CIEDs) are increasingly common interventions for a wide spectrum of cardiovascular diseases. Caring for patients with life-sustaining devices such as CIEDs at the end of life raises legal and ethical challenges. The Electrophysiology & Digital Health Sections seeks to shed light on these issues and improve our understanding of patients’ and clinicians’ experiences with these therapies in older adults, particularly surrounding issues such as device deactivation, generator replacement, and advance directives.
Section Head: Dr. Issa Dahabreh
The Epidemiology & Data Science Section focuses on the development of novel methods of extending causal inferences from one or more trials to target populations and transporting clinical prediction models.
Section Head: Dr. Dhruv Kazi
The Health Economics Section focuses on using real-world data and mathematical modeling to examine the clinical and economic effects of diagnostic tests, new therapies, and public health measures on the cardiovascular health of the population. The overarching goal is to addresses important and timely clinical and policy-oriented questions to equitably advance population cardiovascular health in the US and overseas.
Section Head: Dr. Rishi Wadhera
The Health Policy & Equity Research Section focuses on understanding the impact of state and federal health policies on access, quality of care, and health outcomes, as well the underlying determinants of health inequities, with a specific focus on racial/ethnic disparities, income inequality, and neighborhood disadvantage.
Section Head: Dr. Jordan Strom
The Cardiovascular Imaging Research Section focuses on the evaluation of the impact of imaging on cardiovascular health outcomes, as well as the development of novel tools for preprocedural risk stratification, especially for valvular heart disease.
Section Head: Dr. Eric Secemsky
The Interventional Cardiology & Vascular Research Section focuses on the comparative effectiveness of coronary and vascular therapies, with an emphasis on the use of novel statistical methods.
The Academy for Narrative and Critical Inquiry, created in 2024, is designed to advance writing and critical thinking in medicine. The Academy will aim to equip students, trainees, and clinicians with a skillset that allows them to have a voice in the complex forces shaping healthcare delivery. It strives to create a model for academic medicine that gives those in the trenches the time, space, and skills not just to ask the toughest questions facing medicine, but also begin to answer them.
The Academy is led by Dr. Lisa Rosenbaum.