Emory Report

November 9, 1998

 Volume 51, No. 11

Center for Outcomes Research focuses on heart disease

Cardiovascular disease is the No. 1 killer in industrial countries worldwide, according to cardiologist William Weintraub, director of the Emory Center for Outcomes Research (ECOR). And while many new treatments and technologies are now available to treat heart disease, he said, it's important to understand the outcomes of these therapies.

Information obtained through outcomes research "allows society to make good decisions on how to rationally use resources to combat this great killer," he explained. Founded in 1986, ECOR is currently involved in more than 30 studies in the United States and overseas, and is "one of the leading places in outcomes research in cardiovascular medicine," Weintraub said.

ECOR's multidisciplinary faculty includes clinicians, biostatisticians, health care economists and nurses from a variety of fields and departments within Emory, including the schools of medicine, public health and nursing, and the hospitals.

The center studies clinical, economic and humanistic outcomes in cardiovascular medicine, said Leslie Shaw, ECOR associate director. Clinical outcomes include "the end products of some kind of health care process, such as mortality or patient symptoms," she explained. Humanistic outcomes are quality-of-life issues that incorporate the patient's perspective, she said, while economic outcomes refer to the trade-offs between the benefits and costs of treatment.

ECOR studies primarily focus on two aspects of cardiology-diagnostic imaging and therapeutic interventions. These interventions include coronary bypass surgery, angioplasty, coronary stent use and various medical therapies currently under investigation or already approved. Shaw said. "A number of studies look at approved agents," she added.

The center does its largest volume of work for the Emory Heart Center, collecting and evaluating outcomes data from more than 80,000 former patients to determine the quality of care they received. "By tracking outcomes, we're better able to look at, for example, how well the angioplasties and coronary bypass surgeries have done over time as far as providing quality health care to those patients," Shaw said.

ECOR also provides services to a variety of pharmaceutical and medical device companies by answering questions and helping them develop new agents or new diagnostic tests. "We can look at new contrast ultrasound agents, new radio-pharmaceuticals and new therapeutic agents-the whole spectrum of outcomes assessment, from Phase I trials on drug safety to post-marketing approval," Shaw said.

In December ECOR will begin working on a large project for the Department of Veterans Affairs and the Medical Research Council of Canada at 39 centers across North America. The study will be a randomized trial comparing the outcomes of angioplasty vs. medical therapies such as lipid lowering and aspirin use.

ECOR also is involved in several overseas contracts, which usually involve randomized clinical trials or registries following a patient group. One worldwide trial for a pharmaceutical company involves patients who have acute coronary syndromes. The participants are randomized for conservative or invasive strategy, while the study looks at clinical outcomes and cost effectiveness, Weintraub said. Another study for Bromptom Hospital in London compares the outcomes of angioplasty stents vs. surgery from the standpoint of clinical outcomes, cost effectiveness and quality of life.

"There has been a paradigm shift in health care towards cost containment," Shaw explained. "Our interest is in providing accurate outcomes assessment in order to drive more rational approaches to containing health care cost."

--Linda Klein

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