Selected projects
Aortic stenosis
A CIHR funded project investigating the impact of patient, institutional, physician, and regional data on the trajectory of aortic stenosis (AS) treatment choices, outcomes, and cost effectiveness
Overview
Aortic stenosis (AS) is the most prevalent heart valve disorder in developed countries. Historically, surgical aortic valve replacement (SAVR) has been the standard treatment for symptomatic AS. Trans-catheter aortic valve replacement (TAVR) has now been demonstrated to significantly reduce mortality for inoperable AS patients compared to medical treatment, and to have comparable or improved outcomes compared across a spectrum of SAVR candidates. The most recent randomized trial has shown TAVR to be noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months follow-up in patients at low surgical risk. TAVR has, and will continue to, dramatically change the way patients with AS are managed and may be seen as “disruptive” technology.
It is important to have a clear understanding of the diagnostic, treatment and outcomes experienced by these patients. This is necessary to be sure the appropriate resources are available to meet these demands in a fair, transparent, and equitable manner.
Comparative effectiveness studies of dual antiplatelet therapy (DAPT)
Ticagrelor compared to clopidogrel in acute coronary syndromes (TC4) - the TC4 comparative effectiveness study
CIHR funded project (2019-2023) looking at the comparative effectiveness of ticagrelor versus clopidogrel in acute coronary syndromes.
Overview Cardiovascular diseases, especially acute coronary syndromes (ACS) are a leading cause of mortality and morbidity. Antiplatelet medications have a long history of improving ACS survival and for the prevention of a secondary cardiac event. Based on the consistency and strength of multiple randomized controlled trials (RCTs), the dual antiplatelet therapy (DAPT), clopidogrel and aspirin, following an ACS event, had long been considered the gold standard in the leading clinical guidelines. More recently, a new DAPT regimen, ticagrelor and aspirin, has become the recommended strategy. However this is based largely on one large RCT with a limited number of North American patients (who did not show any incremental benefit).
The Ticagrelor Compared to Clopidogrel in aCute coronary syndromes – the TC4 trial (NCT04057300) – is a pragmatic, open-label, active control, time clustered randomized clinical trial designed to assess the effectiveness and safety of ticagrelor versus clopidogrel as DAPT therapy in a ACS population undergoing percutaneous coronary intervention (PCI) in a single tertiary academic center in Montreal, Canada.
In addition to a standalone analysis, our main Bayesian analysis will incorporate the 1800 PLATO NA patients as our prior distribution, essentially providing a > 50% safety margin for our sample size calculations (see next section).
The complete funding protocol is found here.
This research program will also explore the comparative effectiveness of these different treatments by performing a
i) Bayesian network meta-analysis of all previous RCTs
ii) Pharmacoepidemiology study using Quebec administrative databases (manuscript in progress)
(Mostly) Clinical Epidemiology with R
This is some introductory teaching material related to clinical epidemiology using R.
Hopefully at some point this material will be updated, expanded and repackaged using Quarto