Candidate: Dr. Strom received his BS in Biology from Yale College, an MD from Harvard Medical School, and has completed clinical training in internal medicine (MGH) and cardiology (BIDMC). He is currently enrolled in an MSc program in Epidemiology (HSPH). He is currently Chief Fellow in Cardiovascular Medicine at BIDMC, a research fellow at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, and a non-invasive cardiology fellow at BIDMC. He maintains 75% protected time to conduct clinical research on the BIDMC institutional T32 grant. The candidate?s long- term goal is to become an R01-funded investigator in applied outcomes research, focusing primarily on valvular heart disease. Environment: The candidate will be mentored by Dr. Robert Yeh (Primary Mentor), Associate Professor of Medicine at HMS and Director of the Smith Center for Outcomes Research in Cardiology. He will be supported by Dr. Jeffrey Popma (collaborating investigator) and Dr. Changyu Shen (collaborating investigator), both of whom are internationally recognized leaders in their respective fields and provide complementary expertise relevant to the research and training of the applicant. Dr. Yeh has an established track record of successfully mentoring clinical investigators and has committed research funding to complete the proposed work. Research: Transcatheter aortic valve replacement (TAVR) is rapidly emerging as an alternative for individuals with severe aortic stenosis at intermediate to high risk of adverse outcomes from surgical aortic valve replacement (SAVR), though it is unknown which subpopulations benefit most from each procedure. Through novel linkage of clinical trial data from the US CoreValve Pivotal trials and two large administrative claims databases, we seek to enrich the historical information on trial participants in order to better predict heterogeneity of risk and benefit in the trial population.
In Aim 1, we plan to validate use of administrative claims data to assess clinical comorbidities and outcomes in individuals with aortic stenosis undergoing surgical and transcatheter AVR, utilizing outcomes and covariates rigorously adjudicated by a clinical events committee.
In Aim 2, Part A, we will assess whether administrative claims linked to trial data from the US CoreValve Pivotal Trials can identify novel risk predictors (including those related to patient frailty) and improve risk discrimination compared with trial data alone in individuals undergoing AVR.
In Aim 2, Part B, we will use linked trial and claims data to predict differential benefit of TAVR vs. SAVR in subpopulations of high risk individuals undergoing aortic valve replacement for aortic stenosis.
While treatments continue to advance for aortic stenosis, a fatal and common condition that affects many elderly adults, it is unclear who benefits most from newer transcatheter aortic valve replacement (TAVR) therapies versus traditional surgical aortic valve replacement. Our research aims to link trial and registry data to improve a physician?s ability to predict specific benefits and risks within certain subgroups of individuals. We will validate the use of this new approach, linking claims and trial data, as a novel method to capture information on trial participants and improve the ability to find subgroups with the most benefit/harm to treatments.
