The focus of my research is on the prevention of cardiovascular diseases and to improve patient outcomes through improvement of quality of medical care

Biography

Dr. Wen-Chih Wu is Associate Professor in the Department of Medicine at Brown Medical School. He has conducted research work in the areas of cardiovascular epidemiology and outcomes. He is also interested in tranlational research linking vascular biology and endothelial function to novel imaging techniques. Dr. Wu serves as reviewer in several peer-reviewed journals in cardiology and has been invited as a speaker in local and national meetings. He holds research grants from the VA Merit Review Process, non-for-profit organizations, and the industry. Clinically, he is the attending physician for cardiology at Providence VA Hospital, and teaches cardiology fellows, medical residents and students. Additionally, Dr. Wu is fellowship director of Preventive Cardiology, and has won the Dean's teaching excellence award for the education of medical students. He also received recognition from outstanding teaching to the cardiology fellows and was awarded "Teacher of the Year" in several occasions.

Research Description

VA Health Services Research: IIR 04-313

Variability in Surgical Blood Transfusion Practices and Cardiovascular Outcome

Funding Period: July 2005 - June 2007

BACKGROUND / RATIONALE: Anemia is common in the elderly undergoing surgery and has been associated with an increased morbidity and mortality. Despite the awareness of blood transfusion guidelines, variable transfusion practices still prevail among different practitioners and institutions.

OBJECTIVE(S): Using a merge of the National Surgical Quality Improvement Program (NSQIP) database, the Outpatient Care (OPC) Files, the VA-Medicare dataset and the Patient Treatment Files (PTF), this research is designed to answer two questions: 1) Does blood transfusion during surgery adjusted for hematocrit values, patient comorbidities, types of operation, provider and hospital factors predict 30-day perioperative cardiac or neurologic events in elderly veterans undergoing non-cardiac surgery? 2) Do hospital's blood transfusion guideline adherence rates for elderly veterans during non-cardiac surgery adjusted for medical comorbidites, types of operations, and institutional characteristics predict the hospital's 30-day perioperative cardiac or neurologic event rates of the operated elderly with anemia?

METHODS: This is a cohort study using the clinical and administrative information from the NSQIP database merged with prior cardiac care data obtained from the PTF, OPC and VA-Medicare datasets. We will include all veteran patients age >65 years in the NSQIP data who underwent major non-cardiac surgery in 127 VA hospitals nationwide during 1991-2003. The primary outcome will be 30-day perioperative cardiac or neurologic events (death, myocardial infarction, stroke, cardiac arrest, or coma). We expect a sample of 330,000 patients and analyses will be performed at patient and hospital levels. At the patient level, we will relate anemia to outcomes and use hierarchical regression modeling to conduct a propensity analysis of receiving operative blood transfusions. The hierarchical model is based on the assumption of three levels of nested effects on the decision to transfuse blood: patient factors nested within provider factors, which in turn is nested within institutional factors. Patients will be stratified by their preoperative hematocrit and then distributed in quintiles according to their likelihood of receiving blood transfusions (based on propensity scores), and outcomes of the transfused versus non-transfused cohorts compared. At the hospital level, institutions will be distributed according to their degree of adherence to blood transfusion guidelines, adjusted for the propensity score to receive operative blood transfusions, and compared on the periopeartive event rates of the elderly with anemia.

FINDINGS / RESULTS: No results at this time.

IMPACT: We anticipate this project to improve the outcome of patients undergoing surgery by the identification of high risk groups that would benefit most from blood transfusion therapy, and to decrease the incidence of unnecessary blood transfusions. We will also provide a scientific rationale to the adherence to blood transfusion guidelines and expect to reduce the variability in operative blood transfusion practices.

PUBLICATIONS:
None at this time.

DRA: Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems

DRE: Treatment, Epidemiology
Keywords: Cardiovascular disease, Quality assessment, Surgery

Awards

1999 Medical Resident of the Year
University of Connecticut School of Medicine

2001- America's Most Outstanding Professionals

2002- Physician's Recognition Award
American Medical Association

2001-2003 Dean's Teaching Excellence Award,
Brown Medical School

2002-2005 Teacher of the Year Award
Cardiology Fellowship, Brown Medical School

2010 Beckwith Family Award for Outstanding Teaching in
the Department of Medicine

Affiliations

Professional Licensure and Board Certification

1999- Connecticut medical license

1999- ABIM- Internal Medicine

2001- Rhode Island medical license

2003- ABIM- Cardiology

Academic Appointments

July, 2002- Assistant Professor of Medicine (Cardiology)
Brown Medical School

July, 2010- Associate Professor of Medicine

Hospital Appointments

July, 2002- Staff Cardiologist
Providence VA Medical Center
Povidence, RI

Hospital Committees

2003- IRB Committee

University Committees

2004- Medical Faculty Executive Committee

Membership in Societies

1996- Member, American College of Physicians

1999- Member, American College of Cardiology

1999- Member, American Heart Association

2003- Interdisciplinary Working Group on Quality of Care &
Outcomes Research, AHA

2005- Fellow, American College of Cardiology

Funded Research

2002-2003 Scios, Inc. Acute Decompensated Heart Failure National Registry (ADHERE).W. Wu, PI

2003-2004 Scios, Inc. The use of nesiritide for treatment of acute decompensated congestive heart failure
complicated by acute renal insufficiency. W. Wu, Initiator

2003-2005 Merck, Inc. Effectiveness of different strategies in maintaining target of cardiovascular risk factors in patients discharged from cardiovascular risk reduction clinic

2004-2006 VA HSR&D Target Research Enhancement Program (TREP)
Project:"Combined Behavioral and Pharmacological Intervention for Cardiovascular Risk Reduction in Diabetic Patients".
TREP PI and mentor: Peter Friedmann, M.D.
Mentored Project PI: W. Wu, 25% effort.

2005-2006 RI Foundation Multidisciplinary Behavioral and Pharmacological Intervention for Cardiac Risk Reduction in Diabetes.
W. Wu, Initiator

2005-2007 VA HSR&D "Variability in Surgical Blood Transfusion Practices and Cardiovascular Outcome";
W. Wu, PI Awardee Merit Review

Teaching Experience

ECG course: medical students, medical residents
Preoperative Cardiac Assessment: cardiology fellows
Pathopysiology for medical students: heart failure

Courses Taught

• Pathophysiology (BI0281)

View My Full Publication List in pdf format

Selected Publications

• Patel, PM and Wu, WC. Carotid sinus syndrome. In: Ferri's Clinical Advisor 2006, Ferri, FF [ed], Elsevier, St. Louis, 2006.(2006)
• Patel, PM and Wu, WC. Cor pulmonale. In: Ferri's Clinical Advisor 2006, Ferri, FF [ed], Elsevier, St. Louis, 2006.(2006)
• Patel, PM and Wu, WC. Cardiac tamponade. In: Ferri's Clinical Advisor 2006, Ferri, FF [ed], Elsevier, St. Louis, 2006.(2006)
• Patel, PM and Wu, WC. Aneurysm, abdominal aorta. In: Ferri's Clinical Advisor 2006, Ferri, FF [ed], Elsevier, St. Louis, 2006.(2006)
• Patel, PM and Wu, WC. Tetralogy of Fallot. In: Ferri's Clinical Advisor 2006, Ferri, FF [ed], Elsevier, St. Louis, 2006.(2006)
• Wu, WC and Petropolous, P. Ventricular Septal Defect. In: Ferri's Clinical Advisor 2005, Ferri, FF [ed], Elsevier, St. Louis, 2005.(2005)
• Wu, WC and Petropolous, P. Tricuspid Regurgitation. In: Ferri's Clinical Advisor 2005, Ferri, FF [ed], Elsevier, St. Louis, 2005.(2005)
• Wu, WC and Petropolous, P. Tetrology of Fallot. In: Ferri's Clinical Advisor 2005, Ferri, FF [ed], Elsevier, St. Louis, 2005.(2005)
• Wu, WC and Petropolous, P. Atrial myxoma. In: Ferri's Clinical Advisor 2005, Ferri, FF [ed], Elsevier, St. Louis, 2005.(2005)
• Patel PM, Wu WC. The electrocardiogram in the primary care office. Primary Care Clinics of North America 2005; 32(4):901-30.(2005)
• Mehta SB, Wu WC. Management of coronary heart disease – stable angina, acute coronary syndrome, myocardial infarction. Primary Care Clinics of North America 2005; 32(4):1057-81.(2005)
• Wu WC, Sharma SC, Choudhary G, Coulter L, Coccio E, Eaton CB. Flow Mediated Vasodilation Predicts the Presence and Extent of Coronary Disease Assessed by Stress Thallium Imaging. J Nucl Cardiol 2005; 12(5):538-44.(2005)
• Sebastian CC, Wu WC, Shafer M, Choudhary G, Patel PM. Pneumopericardium and pneumothorax after permanent pacemaker implantation. PACE 2005; 28:1–3.(2005)
• Wu, WC and Petropolous, P. Tricuspid Stenosis. In: Ferri's Clinical Advisor 2005, Ferri, FF [ed], Elsevier, St. Louis, 2005.(2005)
• Aziz GA, Wu WC. Hypertension. In: Primary Care for Women. 2nd ed. Leppert PC, Peippert JF [ed], Lippincott, Williams, & Wilkins: Philadelphia, 2004.(2004)
• Wu WC, Ireland LA, Sadaniantz A. Evaluation of aortic valve disorders using stress echocardiography. Echocardiography 2004;21:451-8.(2004)
• Sadaniantz A, Katz A, Wu WC. Miscellaneous use of stress echocardiography in patients with chronic pulmonary disease or congenital heart defect. Echocardiography 2004;21:477-84.(2004)
• Wu WC, Aziz GF, Sadaniantz A. Evaluation of aortic valve disorders using stress echocardiography. Echocardiography 2004;21:459-66.(2004)
• Wu WC, Bhavsar JH, Sadaniantz A. An overview of stress echocardiography in the study of patients with dilated and hypertropic cardiomyopathy. Echocardiography 2004;21:467-75.(2004)
• Wu WC, Gordon PG. Invasive management of patients with ST elevation MI with >12 hour delay in presentation, the question remains unanswered. Chest 2004:126:2-4.(2004)
• Rathore SS, Wu WC, Krumholz HM. Transfusion in elderly patients with myocardial infarction. Correspondence: authors reply to editor. N Eng J Med 2002;346(10):780-1.(2002)
• Wu WC, Tilkemeier PL. Significance of right ventricular visualization on stress sestamibi in a patient with dyspnea after atrial-septal-defect repair. J Nucl Cardiol 2002:9(2):236-7.(2002)
• Shahi C, Rathore SS, Wang Y, Thakur R, Wu WC, Lewis JM, Petrillo MK, Radford MJ, Krumholz HM. Quality of care among elderly patients hospitalized with unstable Angina. Am Heart J 2001;142(2):263-70.(2001)
• Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Effectiveness of blood transfusion in elderly patients with acute myocardial infarction. N Eng J Med 2001; 345(17):1230-6.(2001)
• Sadaniantz A, Wu WC. Survival of renal transplant patients after first myocardial infarction: a look to the past and promises for the future. Am J Kidney Dis 2000;36:211-3.(2000)
• Salas I, Chan K, Wu WC. Pain relief in cancer patients. San Jose: Editiorial Universidad de Costa Rica 1996. 79 pp. (Spanish).(1996)