Cardiology; Geriatrics; Quality of Health Care; Hospital Medicine
Public Health Interests
Health Care Quality; Medicare/Medicaid
Dr. Dharmarajan's primary interests are in improving health outcomes for older persons with cardiovascular disease. His work has made fundamental contributions to understanding the vulnerability experienced by patients after hospitalization as well as important ways in which hospitals and health systems can help patients avoid rehospitalization. His current work examines the following questions:
1. Has federal policy to reduce hospital readmissions also impacted patient mortality after hospitalization?
2. Have recent reductions in 30-day readmissions across the US been counterbalanced by increased readmissions after the first month following hospitalization?
3. Do common geriatric conditions predict 30-day readmission after hospitalization for common medical conditions?
4. Are estimates for hospital quality using data for Medicare beneficiaries broadly reflective of quality throughout an institution?
5. What are the determinants of recovery in health status (symptoms, functional status, quality of life) after hospitalization?
- Dharmarajan K., Qin L., Lin Z., Horwitz L.I., Ross J.S., Drye E.E., Keshawarz A., Altaf F.K., Normand, S.L., Krumholz H.M., Bernheim S.M. Declining admission rates and thirty-day readmission rates positively associated even though patients grew sicker over time. Health Aff. (Millwood). 2016 Jul 1;35(7):1294-1302.
- Dharmarajan K., Hsieh A.F., Kulkarni V.T., Lin Z., Ross J.S., Horwitz L.I., Kim N., Suter L.G., Lin H., Normand S.L., Krumholz H.M. Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. BMJ. 2015 Feb 5;350:h411.
- Dharmarajan K., Jing L., Xi L., Lin Z., Krumholz H.M., Jiang L.; for the China PEACE Collaborative Group. The China PEACE (patient-centered evaluative assessment of cardiac events) retrospective study of acute myocardial infarction: study design. Circ. Cardiovasc. Qual. Outcomes. 2013 Nov;6(6):732-40.
- Dharmarajan K., Hsieh A.F., Lin Z., Bueno H., Ross J.S., Horwitz L.I., Barreto-Filho J.A., Kim N., Suter L.G., Bernheim S.M., Drye E.E., Krumholz H.M. Hospital readmission performance and patterns of rehospitalization: a retrospective cohort study of Medicare hospitalizations. BMJ. 2013 Nov 20;347:f6571.
- Dharmarajan K., Strait K.M., Lagu T., Lindenauer P.K., Tinetti M.E., Lynn J., Li S.X., Krumholz H.M. Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome. PLoS One. 8(10): e78222.
- Dharmarajan K., Masoudi F.A., Spertus J.A., Li S.X., Krumholz H.M. Contraindicated initiation of beta blocker therapy in patients hospitalized for heart failure. JAMA Intern. Med. 2013 Sep 9;173(16):1547-9.
- Dharmarajan K., Hsieh A.F., Lin Z., Bueno H., Ross J.S., Horwitz L.I., Barreto-Filho J.A., Kim N., Bernheim S.M., Suter L.G., Drye E.E., Krumholz H.M. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013 Jan 23;309(4):355-63.
- Dharmarajan K., Maurer M.S. Transthyretin cardiac amyloidosis in older North Americans. J. Am. Geriatr. Soc. 2012 Apr;60(4):765-74.
Full List of PubMed Publications
- Dharmarajan K, Foster J, Coylewright M, Green P, Vavalle JP, Faheem O, Huang PH, Krishnaswamy A, Thourani VH, McCoy LA, Wang TY: The medically managed patient with severe symptomatic aortic stenosis in the TAVR era: Patient characteristics, reasons for medical management, and quality of shared decision making at heart valve treatment centers. PLoS One. 2017; 2017 Apr 21. PMID: 28430791
- Okunrintemi V, Spatz ES, Di Capua P, Salami JA, Valero-Elizondo J, Warraich H, Virani SS, Blaha MJ, Blankstein R, Butt AA, Borden WB, Dharmarajan K, Ting H, Krumholz HM, Nasir K: Patient-Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States: Medical Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes. 2017 Apr. PMID: 28373270
- Dreyer RP, Dharmarajan K, Kennedy KF, Jones PG, Vaccarino V, Murugiah K, Nuti SV, Smolderen KG, Buchanan DM, Spertus JA, Krumholz HM: Sex Differences in 1-Year All-Cause Rehospitalization in Patients After Acute Myocardial Infarction: A Prospective Observational Study. Circulation. 2017 Feb 7. PMID: 28153989
- Dharmarajan K, Lin Z, Normand ST: Hospitals' Role In Readmissions. Health Aff (Millwood). 2017 Feb 1. PMID: 28167732
- Dharmarajan K, Hsieh A, Dreyer RP, Welsh J, Qin L, Krumholz HM: Relationship Between Age and Trajectories of Rehospitalization Risk in Older Adults. J Am Geriatr Soc. 2017 Feb; 2016 Nov 22. PMID: 27874977
- Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK: Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality. J Am Geriatr Soc. 2016 Dec 30; 2016 Dec 30. PMID: 28039852
- Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI: Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA. 2016 Dec 27. PMID: 28027367
- Dharmarajan K: Comprehensive Strategies to Reduce Readmissions in Older Patients With Cardiovascular Disease. Can J Cardiol. 2016 Nov; 2016 Feb 4. PMID: 27084075
- Mortazavi BJ, Downing NS, Bucholz EM, Dharmarajan K, Manhapra A, Li SX, Negahban SN, Krumholz HM: Analysis of Machine Learning Techniques for Heart Failure Readmissions. Circ Cardiovasc Qual Outcomes. 2016 Nov; 2016 Nov 8. PMID: 28263938
- Krumholz HM, Hsieh A, Dreyer RP, Welsh J, Desai NR, Dharmarajan K: Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. PLoS One. 2016; 2016 Oct 7. PMID: 27716841
- Rosen JE, Salazar MC, Dharmarajan K, Kim AW, Detterbeck FC, Boffa DJ: Length of Stay From the Hospital Perspective: Practice of Early Discharge Is Not Associated With Increased Readmission Risk After Lung Cancer Surgery. Ann Surg. 2016 Aug 25; 2016 Aug 25. PMID: 27564681
- Dharmarajan K, Strait KM, Tinetti ME, Lagu T, Lindenauer PK, Lynn J, Krukas MR, Ernst FR, Li SX, Krumholz HM: Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure. J Am Geriatr Soc. 2016 Aug; 2016 Jul 22. PMID: 27448329
- Zeitler EP, Wang Y, Dharmarajan K, Anstrom KJ, Peterson ED, Daubert JP, Curtis JP, Al-Khatib SM: Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol. 2016 Jul. PMID: 27406605
- Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM: Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Aff (Millwood). 2016 Jul 1. PMID: 27385247
- Dharmarajan K, Dunlay SM: Multimorbidity in Older Adults with Heart Failure. Clin Geriatr Med. 2016 May; 2016 Feb 18. PMID: 27113146
- Zheng X, Curtis JP, Hu S, Wang Y, Yang Y, Masoudi FA, Spertus JA, Li X, Li J, Dharmarajan K, Downing NS, Krumholz HM, Jiang L, China PEACE Collaborative Group.: Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study. JAMA Intern Med. 2016 Apr. PMID: 26974883
- Dharmarajan K, Chaudhry SI: New Approaches to Reduce Readmissions in Patients With Heart Failure. JAMA Intern Med. 2016 Mar. PMID: 26857025
- Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM: Hospital variation in admission to intensive care units for patients with acute myocardial infarction. Am Heart J. 2015 Dec; 2015 Sep 11. PMID: 26678638
- Dharmarajan K: Variation in care and outcome following myocardial infarction. BMJ. 2015 Aug 7; 2015 Aug 7. PMID: 26254446
- Dreyer RP, Ranasinghe I, Wang Y, Dharmarajan K, Murugiah K, Nuti SV, Hsieh AF, Spertus JA, Krumholz HM: Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction. Circulation. 2015 Jul 21; 2015 Jun 17. PMID: 26085455
- Dodson JA, Wang Y, Murugiah K, Dharmarajan K, Cooper Z, Hashim S, Nuti SV, Spatz E, Desai N, Krumholz HM: National Trends in Hospital Readmission Rates among Medicare Fee-for-Service Survivors of Mitral Valve Surgery, 1999-2010. PLoS One. 2015; 2015 Jul 6. PMID: 26147225
- Arnold SV, Li SX, Alexander KP, Spertus JA, Nallamothu BK, Curtis JP, Kosiborod M, Gupta A, Wang TY, Lin H, Dharmarajan K, Strait KM, Lowe TJ, Krumholz HM: Hospital variability in use of anticoagulant strategies during acute myocardial infarction treated with an early invasive strategy. J Am Heart Assoc. 2015 Jun 15; 2015 Jun 15. PMID: 26077589
- Dharmarajan K, Kim N, Krumholz HM: Patients need safer hospitals, every day of the week. BMJ. 2015 Apr 15; 2015 Apr 15. PMID: 25877669
- Al-Damluji MS, Dharmarajan K, Zhang W, Geary LL, Stilp E, Dardik A, Mena-Hurtado C, Curtis JP: Readmissions after carotid artery revascularization in the Medicare population. J Am Coll Cardiol. 2015 Apr 14. PMID: 25857904
- Dharmarajan K, Hsieh AF, Kulkarni VT, Lin Z, Ross JS, Horwitz LI, Kim N, Suter LG, Lin H, Normand SL, Krumholz HM: Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. BMJ. 2015 Feb 5; 2015 Feb 5. PMID: 25656852
- Murugiah K, Wang Y, Dodson JA, Nuti SV, Dharmarajan K, Ranasinghe I, Cooper Z, Krumholz HM: Trends in hospitalizations among medicare survivors of aortic valve replacement in the United States from 1999 to 2010. Ann Thorac Surg. 2015 Feb; 2014 Dec 16. PMID: 25527425
- Dharmarajan K, Krumholz HM: Risk after hospitalization: we have a lot to learn. J Hosp Med. 2015 Feb. PMID: 25627350
- Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM: Intravenous fluids in acute decompensated heart failure. JACC Heart Fail. 2015 Feb. PMID: 25660836
- Wang Y, Lichtman JH, Dharmarajan K, Masoudi FA, Ross JS, Dodson JA, Chen J, Spertus JA, Chaudhry SI, Nallamothu BK, Krumholz HM: National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010. Am Heart J. 2015 Jan; 2014 Jun 14. PMID: 25497251
- Dharmarajan K, Krumholz HM: Strategies to Reduce 30-Day Readmissions in Older Patients Hospitalized with Heart Failure and Acute Myocardial Infarction. Curr Geriatr Rep. 2014 Dec 1. PMID: 25431752
- Ranasinghe I, Wang Y, Dharmarajan K, Hsieh AF, Bernheim SM, Krumholz HM: Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study. PLoS Med. 2014 Sep; 2014 Sep 30. PMID: 25268126
- Chaudhry SI, Khan RF, Chen J, Dharmarajan K, Dodson JA, Masoudi FA, Wang Y, Krumholz HM: National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc. 2014 Sep 23; 2014 Sep 23. PMID: 25249298
- Fazel R, Strait KM, Bikdeli B, Dharmarajan K, Krumholz HM: Use of intravenous diuretics on day of discharge in adults hospitalized for heart failure. J Card Fail. 2014 Sep; 2014 Jun 18. PMID: 24951932
- Kulkarni VT, Kim N, Dai Y, Dharmarajan K, Safavi KC, Bikdeli B, Lindenauer PK, Testani J, Dries DL, Krumholz HM: Hospital variation in noninvasive positive pressure ventilation for acute decompensated heart failure. Circ Heart Fail. 2014 May; 2014 Mar 14. PMID: 24633829
- Safavi KC, Li SX, Dharmarajan K, Venkatesh AK, Strait KM, Lin H, Lowe TJ, Fazel R, Nallamothu BK, Krumholz HM: Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes. JAMA Intern Med. 2014 Apr. PMID: 24515551
- Dharmarajan K, Krumholz HM: Caution warranted when defining contraindications in initiating β-blocker therapy--reply. JAMA Intern Med. 2014 Mar. PMID: 24590098
- Chen J, Hsieh AF, Dharmarajan K, Masoudi FA, Krumholz HM: National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010. Circulation. 2013 Dec 17; 2013 Nov 4. PMID: 24190958
- Dharmarajan K, Li J, Li X, Lin Z, Krumholz HM, Jiang L, China PEACE Collaborative Group.: The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective study of acute myocardial infarction: study design. Circ Cardiovasc Qual Outcomes. 2013 Nov; 2013 Nov 12. PMID: 24221838
- Dharmarajan K, Strait KM, Lagu T, Lindenauer PK, Tinetti ME, Lynn J, Li SX, Krumholz HM: Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome. PLoS One. 2013; 2013 Oct 21. PMID: 24250751
- Dharmarajan K, Masoudi FA, Spertus JA, Li SX, Krumholz HM: Contraindicated initiation of β-blocker therapy in patients hospitalized for heart failure. JAMA Intern Med. 2013 Sep 9. PMID: 23797379
- Safavi KC, Dharmarajan K, Kim N, Strait KM, Li SX, Chen SI, Lagu T, Krumholz HM: Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States. Circulation. 2013 Feb 26; 2013 Jan 25. PMID: 23355624
- Chen SI, Dharmarajan K, Kim N, Strait KM, Li SX, Safavi KC, Lindenauer PK, Krumholz HM, Lagu T: Procedure intensity and the cost of care. Circ Cardiovasc Qual Outcomes. 2012 May; 2012 May 10. PMID: 22576844