Medical Student Research Fellowship for Summer 2010

Mentor: Sharon C. Reimold, MD
Department: Internal Medicine
Room number: HA9.133
a) Mail Code: 9047
Phone number: 214.645.7521
E-mail: Sharon.Reimold@UTSouthwestern.edu
Project title: Patient Testing, Referral and Treatment Patterns after Abnormal Echocardiogram Results: A Retrospective Review

Human subjects IRB approved project number (where applicable): 022010-041

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:

The American College of Cardiology and the American Heart Association (ACC/AHA) have published specific guidelines concerning patients with valvular heart disease. Despite detailed guidelines, studies indicate that the current treatment of valvular heart disease is discordant with current recommendations. Data from the Euro Heart Survey, a prospective study evaluating the characteristics, treatment, and outcomes of patients with valvular heart disease, found that appropriate care according to published guidelines did not occur in 1 in 5 patients with aortic regurgitation and up to 1 in 3 patients with aortic stenosis or mitral regurgitation. Practice patterns in mitral stenosis have not been described. Since echocardiography is a frequent point of contact for patients with valvular heart disease, the echocardiography laboratories are promising sites for a potential quality improvement initiative aimed at improving compliance with guidelines, and, by extension, patient outcomes.

The purpose of this retrospective cohort study is to characterize the current testing, referral, and treatment patterns in patients with severe aortic or mitral valve disease or with significant pulmonary hypertension as practiced at Parkland Health and Hospital System, and to compare this practice pattern to published ACC/AHA guidelines. With this information, we hope to identify current strategies that are effective and plan modifications or novel strategies to improve the quality of patient care.

Queries will be performed to identify subjects who may meet the inclusion criteria in the Cardiovascular Information Management System under echocardiogram reports. Subjects meeting the inclusion criteria will have existing clinical data collected. This will include demographic information, co-morbid conditions, laboratory results, referrals placed, and procedures performed. Data to characterize the overall health of each patient and to calculate and estimated risk for surgical intervention will also be collected. The data will then be used to characterize the current practices of additional testing, referrals and therapy for each of the valvular lesions and pulmonary hypertension. Possible explanations for observed patterns will be explored.

Student duties would include assistance with data acquisition, entry, and interpretation. There will be the opportunity for poster presentations and manuscript publications.

Previous Research Activities or Publications with Medical Students:

Dr. Reimold has extensive experience working with undergraduate students, medical students, residents, and fellows over the last 20 years on research projects.