Pamela Douglas, M.D., M.A.C.C., F.A.S.E., F.A.H.A.

Pamela Douglas, M.D., M.A.C.C., F.A.S.E., F.A.H.A. Ursula Geller Professor of Research in Cardiovascular Diseases, Duke University Medical Center, Durham, North Carolina PROMISE Trial: Clinical Coordinating Center Administered by the NHLBI Division of Cardiovascular Sciences, Clinical Applications and Prevention Branch FY 2009 Recovery Act Funding: $5,566,450 Additional Funding: PROMISE Trial: Clinical Coordinating Center Administered by the NHLBI Division of Cardiovascular Sciences, Clinical Applications and Prevention Branch FY 2010 Recovery Act Funding: $8,046,691 More information about the grant Total funding: $13,613,141

Research focus: Over 10 million Americans develop chest pain each year, often requiring testing to determine if heart disease is to blame. However, tests can be imprecise, and their costs are rising faster than any other area of health care. Doctors now have new technology at their disposal, such as coronary computed tomographic angiography (CTA), but the role of this technology in diagnosis and treatment is uncertain. Pamela Douglas, M.D., will be leading a multicenter, randomized clinical trial to help answer these questions by evaluating and comparing different testing methods.

"The goal of our research is to understand the best way to distinguish between simple chest pain versus critical heart disease so physicians can set the correct course of treatment for patients," said Dr. Douglas. "No one has ever tested one test against another to determine the best choice for an individual. We will evaluate new technologies that let us look at the heart and arteries in unique ways to find out if they are more effective than traditional approaches."

Supported by the National Heart, Lung, and Blood Institute (NHLBI) through the American Recovery and Reinvestment Act (Recovery Act) funds, PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), is the first study to compare how two types of cardiovascular imaging procedures influence whether or not patients live longer, or subsequently have heart attacks, complications, or angina requiring hospitalization. This comparative effectiveness research (CER) study will involve 10,000 participants at low to intermediate risk of coronary artery disease who will be followed for about 2.5 years. PROMISE will be conducted at 150 sites and has been specifically designed to look at how patients are treated in the real world by incorporating the full spectrum of locations where people seek care. PROMISE will also study the types of tests that are immediately relevant to the clinical decisions needed to care for the vast majority of chest pain patients nationwide.

"We are not just looking at one step but an entire process," said Dr. Douglas. "We will be evaluating not just a test but an approach for diagnosing symptoms and choosing a treatment plan."

By determining the impact of diagnostic testing on patient health, PROMISE's results will define care and shape health policy for the millions of people referred for stress testing each year, determine the value of stunning new technologic advances, and address rising health care costs.

Economic Impact: The NHLBI Recovery Act funds will help partially support the hiring of several project leaders and coordinators who will oversee this large clinical trial at the Duke Clinical Research Institute (DCRI).

"This grant is paradigm changing," said Dr. Douglas. "Never before have we looked at diagnostics in this way to understand the value they bring to patient care. In the past, our focus has been on determining if the tests are accurate and specific, but not if they improve people's health. We are honored that the NHLBI also recognized the importance of this work."

A Routine Day: "I'm very active as both a clinical cardiologist and clinical researcher," said Dr. Douglas. "I lead clinical trials and outcomes and quality assessment projects. These projects are designed to evaluate how imaging is used, the appropriate patients to test and ways to measure the impact of how doctors use imaging in their practices."

Dr. Douglas also oversees the DCRI Imaging Core Lab, a central lab that evaluates imaging results from multi-site clinical trials. The lab has several high-profile ongoing studies.

On Becoming a Scientist: "I've always been interested in medicine, science, and biology," said Dr. Douglas. "I chose my specialty of cardiology because I truly enjoy taking care of sick people. As a resident, I found my time in the intensive care unit to be most fulfilling; I enjoyed caring for people and utilizing all the resources at my disposal to help people feel better. At the same time, I've always been drawn to academics. Imaging is so compelling as a field – it's amazing to just to see the heart beating."

Time Outside the Lab: "I love traveling!" said Dr. Douglas. "My husband and I try to take vacations that are in the outdoors and active. This summer we went hiking in the Alps, which was simply breathtaking. I also enjoy spending time with my cats and serve as the official wine taster for my husband, who is a wine aficionado."

Breakthrough Hope to Achieve in Scientific Career: "While imaging is a legitimate science in the engineering field, my goal is to have imaging recognized in the same way for clinical care," said Dr. Douglas. "We need to utilize the research done in biomedical engineering, translate that work into clinical trials, and translate those clinical trial findings into good clinical practice."

By Lindsey Willis

Last Updated:August 10, 2010