Medical Student Research Fellowship for Summer 2009
Mentor: Amit Khera, MD, MSc
Department: Internal Medicine/Cardiology
Mail Code: 9047
Phone number: 214-645-7536
Project title: Role of ethnicity in program completion and risk factor reduction in a phase 2 cardiac rehabilitation program
Human subjects IRB approved project number (where applicable): Pending but submitted for review
Animal subjects IRB approved project number (where applicable):
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects): Patient-based research.
Brief Description of Project:
Cardiac rehabilitation is an organized, multifaceted program for patients with recent heart attacks, heart bypass surgery, or coronary artery interventions as well as other cardiac diagnoses that is designed to optimize a cardiac patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes. In other words, cardiac rehabilitation is an organized, concerted approach to secondary prevention in order to control cardiovascular risk factors and steer patients towards a healthier life style. Several studies have demonstrated that exercise-based cardiac rehabilitation reduces total mortality for such patients. Prior studies have shown that ethnic disparities exist for cardiac rehab, from referral, to enrollment and completion of the programs. Although data have been published regarding ethnic differences in secondary prevention outcomes in cardiac rehabilitation between blacks and whites, there are literally no data in the literature to evaluate how Hispanics fare. Given that Hispanics are the largest and fastest growing minority group in the United States, and the fact that cultural and language differences may affect the process and outcomes of care for these individuals, it is crucial to assess whether Hispanics have similar outcomes to other racial and ethnic groups participating in cardiac rehabilitation. The cardiac rehabilitation program at Parkland Memorial Hospital (PMH) provides a unique environment to study racial/ethnic differences in program outcomes, as program participants have a common insurance provider and similar socioeconomic status, which are a major confounders in all healthcare related studies.
The objectives of this study are 1) To determine the completion rates for Hispanic patients enrolled in outpatient cardiac rehabilitation at PMH, and compare these rates with other racial/ethnic groups 2) To assess for improvements in secondary prevention core measures in Hispanics relative to other racial/ethnic groups. This study will involve a retrospective patient chart review of approximately 500 patients using available data from patient charts in medical records department, shadow files in the cardiac rehabilitation department and electronic databases like vCDR and CIMS. After the database is completed, the student along with other co-investigators will be involved in data analysis, data interpretation, and manuscript preparation.
A participating medical student would be a co-investigator in the project and will participate in data extraction and completing the database, statistical analysis, and manuscript preparation. This would be a great educational opportunity to familiarize oneself with biostatistics and study design as the study is just being initiated, as well as to learn about cardiac rehabilitation and general clinical cardiology. Finally, he or she not only has the ability to participate in the current project, but also future projects that arise from the created database.
Previous Research Activities or Publications with Medical Students:
Chen K, Lindsey JB, Khera A, De Lemos JA, Ayers CR, Goyal A, Vega GL, Murphy SA, Grundy SM, McGuire DK. Independent associations between metabolic syndrome, diabetes mellitus and atherosclerosis: observations from the Dallas Heart Study. Diab Vasc Dis Res. 2008;5(2):96-101.
-- Karen Chen was a summer medical student with Dr. Khera's research group
Maroules CD, McColl R, Khera A, Peshock RM. Assessment and reproducibility of aortic atherosclerosis magnetic resonance imaging: impact of 3-Tesla field strength and parallel imaging. Invest Radiol. 2008;43(9):656-662.
Maroules CD, McColl R, Khera A, Peshock RM. Interstudy reproducibility of SSFP
cine magnetic resonance: impact of magnetic field strength and parallel imaging.
J Magn Reson Imaging. 2008;27(5):1139-1145.
-- Chris Maroules was a Doris Duke Scholar who is graduating with an MD degree with distinction in research. Dr. Khera served as one of his research mentors and thesis advisors.
Yorio J, Viswanathan S, See R, Uchal L, McWhorter JA, Spencer N, Murphy S,
Khera A, de Lemos JA, McGuire DK. The effect of a disease management algorithm
and dedicated postacute coronary syndrome clinic on achievement of guideline
compliance: results from the parkland acute coronary event treatment study.
J Investig Med. 2008;56(1):15-25.
-- Jeff Yorio and Sundeep Viswanathan both graduated with an MD degree with distinction in research. Dr. Khera served as one of his research mentors and thesis advisors.