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Oby Ukadike: From the campus of Harvard Medical School, this is ThinkResearch!, a podcast devoted to the stories behind clinical research. I'm Oby, your host. ThinkResearch! is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center, and by NCATS, the National Center for Advancing Translational Sciences.

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Join us as we talk to Dr. Frans Serpa about his keen interest in cardiology, health equity, health economics, and electrophysiology. Dr. Serpa is a Research Fellow at the Smith Center for Outcomes Research in Cardiology, which is affiliated with the Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Serpa has led various research projects exploring the epidemiology, outcomes, and cost associated with different cardiovascular conditions.

Hi, Frans. Welcome to the show. Great to have you here.

Frans Serpa: Hi, Oby. Thank you for having me. It's a pleasure. Thank you for the invite.

Oby Ukadike: Of course. Could you start by introducing yourself, telling us where you are from, where did you grow up, giving us a little history, and your path to where you are now?

Frans Serpa: Absolutely. Well, my name is Frans Serpa, and I'm a medical doctor currently working as a Research Fellow at the Smith Center for Outcomes Research in Cardiology, which is part from the Beth Israel Deaconess Medical Center in Boston.

I grew up in one country in South America, Ecuador. It's a small, beautiful country you might have heard of from the Galapagos Island and the theory of evolution from Charles Darwin. I grew up there. I also lived for a couple of years in Brazil, another country in South America. And so I gained all these different cultures in my life, which really helped me.

But then, as a family, we moved back to Ecuador when I was about in high school. And then I decided to pursue medicine as a career. I went into medical school in my country. Right after it, I got very interested in research and very interested in cardiology specifically. And so I knew that I wanted to do something related to cardiology.

I went and did a couple of rotations in the US-- so just to get to know more about the health care system. And so after I finished my medical training, I went to Boston for a research fellowship position initially through a program called International Research Initiative Program from the Beth Israel Deaconess. And I started to work in cardiology, specifically in the area of cardio genetics, which was new for me and very interesting. So I was very excited to be there, had great mentors over there.

And throughout that year, I learned a lot, worked in the clinic and worked also in projects related to some heart conditions called inherited cardiomyopathies and congenital arrhythmias, which is basically some conditions that have to deal with abnormal heart rhythms. And some of them actually run in families. So this is why they are genetic.

Throughout that time, I got very interested also in one specific field from cardiology, which is called electrophysiology, which deals with the abnormal heart rhythms of the heart. I wanted to know a little bit more about this, so I started to reach out to mentors and other doctors in the area and got both involved in the clinical aspect, but also in the research aspect.

And then after finishing that previous one year that I was telling you, I got a unique opportunity to go to my current position at the Smith Center for Outcomes Research, where I could continue my work in the electrophysiology, which was the field that I was interested to work on in the future, and it also combines all of the other aspects that I was very interested throughout medical school and also recently basically related to health equity and trying to understand health economics as well. At this place, I was able to combine and work in all of these aspects that I was very interested within the area of cardiology and, more specifically, within the specific area of electrophysiology, which also was something that I was interested in.

So again, this was just unique and perfect opportunity for me. And throughout this year, I've had incredible mentors. I've worked in amazing projects, both nationally, but also from the Center using national databases, just trying to understand the epidemiology and perform some works and analysis related to health equity, health economics, and outcomes in the field of cardiology.

Oby Ukadike: Yeah. Thank you so much for that background. Can you talk to us a little bit about your research? What are you doing now? So I heard you talk about health equity. I think you said electrophysiology and health economics. And can you combine that together and talk to us about what you're working on now?

Frans Serpa: There are a couple of things which I'm doing. On one hand, I'm working with my primary mentor, Dr. Daniel Kramer, from the Beth Israel Deaconess Medical Center. And we're working on projects that are basically looking into the experiences and trajectories of patients who have cardiac defibrillators, which are these devices that help people that have abnormal heart rhythms. And this is some projects that are multicentered in different hospitals in the US. So this is one area that's very interesting and very novel.

And on the other side, as part of my work as a Research Fellow in the Center, I'm also running and performing some novel analysis to trying to understand the epidemiology and health equity in certain aspects of cardiology. For example, one project that we worked on this year was trying to understand the differences in the risk and factors in the prevalence of certain cardiac conditions for different ethnic subgroups within the Hispanic Latino community.

So as you know, here in the US, basically we often talk about Hispanic and Latinos as a whole group, but we also know that it's a large group. And within this community, we have small subgroups. Some people come from South America, some from Central America, and so on. So having this different background, there must be something that is also changing their risk factors and also probably their conditions-- the probability of having a cardiovascular condition. So that was something that was I was very interested in.

To do that, we basically looked into a national database, and we basically assess what are the risk factors, basically the prevalence for certain conditions and within this community and specifically within the subgroups. And we found incredible differences, which we were expecting. But it is great that we were able to find it, and now it's going to be under review for publication.

And basically, the idea is that we want to make people aware that there are these differences, and we should provide more personalized care for certain groups. So this is one project. And then one recent project that I also sent for publication is looking into the health economics of having a condition called atrial fibrillation, which is a very common heart condition, which basically means that the person has an abnormal heart rhythm.

So basically, the upper chambers of the heart do not beat fast and uncoordinated with the lower chambers of the heart. This condition is extremely prevalent in the US, and it's growing. It's very common within the elderly group.

And so as the population is aging, we're starting to see more and more of this condition in the US. And so we wanted to also not only understand the pathophysiology, but also the health economics. What does it mean to have this condition in the US? How much does it cost? And again, to do that, we basically use a national database, and we were trying to answer a question that we had, which was basically, how much does it cost to have this condition? So say if you compare two people, one has the condition and the other doesn't, so what is the financial burden for the person who has the condition? And we were able to find a specific number.

And the number is not that good because it carries a lot of economic burden for these patients. And also, we were able to actually see a specific services are costing more for this patient. For example, hospitalizations, prescribed medications were the highest cost for these people. So basically, this is important because this will allow policy makers to try to understand how to perform reforms and improve insurance and maybe even for providers and even for patients just trying to understand the burden that it carries and how to mitigate those and work towards that.

Oby Ukadike: That is really interesting. I wrote down a few things that I wanted to go back-- when you were talking about the two different prongs of your research and the things you've been working on, and maybe even start to define some of the terminology you're using because you talk about it all the time. I'm sure you're very steeped in it with your research, but just making sure all of us, as the listeners, understand about health equity, and then about the larger health economics.

They're both pretty literal terms, but if you wanted to give a little more context around them. And then when you think about the two different research projects you were just talking about, how do you see this improving health care, improving the research field in everyday life? You started to talk about that a little bit, especially when I think about personalized care and even this data you went through and looked at how people who fall under one umbrella-- what we're talking about a race umbrella, right? But then you really start to look at the individuals and the smaller demographics in that. How do you see that really improving health care?

Frans Serpa: Yeah. So basically, just definition for some terms. So I talked about health equity.

And this is a term that we often listen to, but it involves so many things. So just the basic idea is that it's trying to ensure that everyone receives the highest care possible. Regardless of the social determinants of health of these people, the disparities or maybe the access to health care, people working on these areas just try to provide a fair distribution of resources and health care to everyone.

So that is what that means. And as I said, this involves so many things. So trying to understand social determinants of health is extremely important because sometimes we often spend too much time understanding the pathophysiology and all of those things, which are extremely important, but it is also important to understand what are the social factors that are driving these differences within some groups or even in general for certain conditions. So that was basically the work that I was referring to.

And then the second question was basically, how can we use this to improve healthcare, right? Well, whenever we want to make any change, which could be policy, or improve health care access, or any of those things, we have to first understand what's going on. And understanding this is important because we can use this information to work with the stakeholders at different levels just to try to improve health care delivery, health care quality, and also sometimes even improve access and also conduct some policy changes that may help some people or some groups and, at the end, maybe the entire population.

So the first thing is understanding what's going on at a national level. It is important because that way, we start to see trends, we start to see gaps. And then once we identify those potential areas, we can work together with stakeholders, as I said, and even providers and patients who might use this information to improve their quality of care and also their experience in the health care system.

Oby Ukadike: And when you think about the work that you're doing, how do you hope it will be used to improve health care, to improve everyday life, to improve the research field? I heard you talk a little bit about policy changes, about better individualized care, not only for the provider, but for the patient. So I'd be curious how you would answer that, how you hope your research will impact and influence these three different areas.

Frans Serpa: The best answer I could give you is just referring to the projects that I've been working on. So for example, for the first part that I mentioned, that I'm involved in some multicenter projects, trying to assess the life experience and trajectories of patients who have this cardiac devices called ICDs or cardiac defibrillators-- that is important because once we understand how patients, family members, and also providers feel we might be able to give personalized care for this patient. And also, when time comes or certain conditions where they would have to deactivate these devices or maybe come down into difficult situations where they have to talk with family members and providers or what to do next, whether they want to continue with the device or not. Understanding all of those aspects, it is important for us to provide personalized care for this patient.

And then on the other side, for the projects that I've been working on specifically, so I mentioned the one that we were looking into this differences within the Hispanic Latino community. I think this is extremely important because once we start to understand that ethnicity is a social determinant, which is important for everyone, but also in certain communities, it plays a huge role, you can see differences in the risk factors and conditions. And so understanding that we are all humans, but we also have different backgrounds, we carry a history, and we all have different cultures.

That is important for the providers, first, because they can then provide personalized care for patients. And then also, it helps patients on the other side because they will feel more confident about the care that they're given. Even some populations might feel safer in going to get health care.

And then the last one, this health economics analysis, this national analysis that we perform-- the idea is just trying to identify areas where patients who have this specific condition, atrial fibrillation, they are spending more as compared to their counterparts. And so identifying the areas where they are spending more is important because that way we can know how to work with stakeholders and policy makers to just to try to expand coverage, for example, if it's for insurance or maybe have policy reforms that try to decrease the cost for certain medications, for example.

One of the areas that we found was that basically hospitalizations play a huge cost for this patients. Understanding that means basically that patients with this condition are going a lot to the health care system, to the hospitals. And maybe it is because they don't have adherence with their medications, or they might have other conditions that are causing them problems. And so understanding that and trying to work together with stakeholders, patients, and also providers, it is important for us to combine all this knowledge and come down to the idea of providing personalized care and identifying these areas where we can mitigate this problem. At the end of the day, it's just trying to improve health care access and quality of care for everyone.

Oby Ukadike: It's a really great point. And even as you were talking, I was thinking about this question, which is going to be an opinion question from me to you. But in your opinion, what kind of education and learning has to happen for a medical professional to-- I guess, to adopt what you're talking about? And what I mean by that is this.

I hear you talking about patients understanding their history. You always talk about family history, right? What did your mom have? What did your dad have? Grandparents, whatever the case may be. But also understanding some of the cultural or demographic history of where you're from and what that may mean for your health.

And maybe there's a two-pronged question here. One is, do you think that is becoming more commonly accepted, if you will, by medical professionals, really internalizing that and understanding that people are different? And then two, do you think there's additional education? Even from you going through medical school and being a researcher now, do you think there are any additional things that need to happen to help people better understand that perspective?

Frans Serpa: For me, it was maybe easier since, as I said, I grew up in different countries in South America, so I was able to see how different the health care system in other countries. But also, I was able to really see myself how the social determinants play in the lives of different people. For me, I always grew up knowing that there were these factors that were driving this disparities in health care.

Once I came to the US, I also realized that some are the same, but there are others. And more importantly, we have huge communities here, which each one of them have their own necessities, and their own disparities, and their own areas to work on. In my opinion, this is something that is growing, at least in the medical field. It is something that has grown in medical schools.

For example, I think most medical schools now, they are taking this curriculum of social determinants of health, and everyone is also very aware of health equity and how this play a role in certain conditions, and so on. I feel like, for the public, this is something that we should start to be more open about, and people should know more. I'm confident that the research that we do needs to go directly to the people. It's not something that we as researchers need to perform and conduct analysis and just go ahead and publish those findings.

But we also need to communicate what we found in a simple way to the public because, at the end of the day, that's where we want to end up. We want to make people understand what's going on, and what's new, and how we can change. And maybe some might relate more than others, but it will help at the end of the day. So I think a key area to work on, at least now and in the future, would be how to translate what we find in research towards the public.

Oby Ukadike: It's a great point. Well, what's next for you? What's next in your research? What are you working on next? Are you still staying on the two projects that you were telling us about?

Frans Serpa: Yeah. So one project that we recently started-- also in the area of cardiology, specifically electrophysiology-- basically, in the field, many of the providers perform many procedures, interventions for patients just to treat their conditions. We started to realize that most of the patients that get these procedures are from certain specific groups, meaning it could be race, ethnicity, or even income level. One of the projects that we're working on is trying to identify, what are the drivers and specifically the social determinants that are driving the access to these procedures in the US using a national database from the data from Medicare?

Oby Ukadike: Thank you so much for being here today and talking to us about your research, talking to us about the amazing work you're doing and the different perspectives that you're bringing to your professional career and to medicine. We look forward to catching up with you and hearing about where this takes you, and what new things you find, and what new things you implement, and maybe the policy changes that you influence. So thank you again for being here. We really appreciate it.

Frans Serpa: Thank you for the invite. It's been a pleasure.

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Oby Ukadike: Thank you for listening. If you enjoyed this episode, please rate us on iTunes, and help us spread the word about the amazing research taking place across the Harvard community and beyond. We are always looking to connect and collaborate with the research community and would like to hear from you. Please feel free to email us onlineeducation.catalyst.harvard.edu to inquire about being a guest on the podcast.