As part of our “Meet Yale Internal Medicine” series, today’s featured physician is Nihar Desai, MD, MPH, associate professor (cardiovascular medicine).
The path cardiologist Nihar Desai, MD, MPH, took to medicine was a circuitous, atypical one, he admits. After studying government as an undergraduate, Desai went to work in Washington, D.C. Based on the 2000 presidential election results and a change in administration, he realized his career was at a crossroads. He contemplated law school, but after reading the Institute of Medicine (US) Committee on Quality of Health Care in America’s reports, “To Err Is Human,” and “Crossing the Quality Chasm,” his interest in medicine was piqued. The reports looked at medical errors and the quality of U.S. healthcare.
He returned to his home state of Connecticut for medical school and then moved to Boston to get master’s degree in public health focusing on health policy. Desai decided to stay in Boston for his internal medicine residency and cardiology fellowship. Since he was drawn to health policy work, Desai hadn’t considered cardiology as a career path but during his internship, he met one of his mentors, Marc Sabatine, MD, MPH. After numerous discussions with Sabatine about his desire to pursue work in public health, quality of care and cardiovascular outcomes research, the duo thought that cardiovascular medicine would be “right in the middle of all of it.”
“When you think about the number one killer in the U.S. and now globally, there is a huge burden of cardiovascular disease, hypertension, and diabetes,” explained Desai. “Within cardiology, we have a large body of evidence, many clinical trials, and clinical practice guidelines, so thinking about adoption and quality improvement makes sense. It's a logical part of the journey going from an idea to ultimately impacting clinical practice. I was drawn to that and so that was the reason for my ‘detour’ into cardiovascular medicine as well.”
Desai dove into clinical trial work, testing new treatments. “I was doing a clinical trials in cardiology, testing new therapies, and new devices and I loved it, but what kind of struck me was one of the problems that we were facing,” he said. “Often times, we knew what the best therapy was but we weren't good at making sure that everyone got them; translating evidence into practice.”
The identification of this ‘deficit’ would alter his career path again. He started thinking about the policy work that motivated him to go into medicine in the first place. This idea would lead him to Yale School of Medicine (YSM) cardiologist Harlan Krumholz, MD, SM, and The Center for Outcomes Research & Evaluation (CORE), a national outcomes research center working to assess healthcare quality and evaluate clinical decision making and the comparative effectiveness of specific healthcare interventions.
Desai came home to Connecticut to join Krumholz and the team at CORE.
“It was the perfect marriage of the clinical and academic work that I wanted to pursue,” said Desai. “This place, this health system, and this community was one that I always felt connected to and then from a personal standpoint, it really fit. CORE is a place that aspires to conduct scholarship with the hope of having an impact, making the healthcare system safer, the quality of care better, and hopefully improving the health of individuals and communities.”
Through his work at CORE, Desai and team have had some critical findings. Desai and his colleagues looked at patterns of care of patients with acute myocardial infarction and cardiogenic shock and examined the comparative effectiveness of different mechanical circulatory support devices. In July 2018, he and co-author Jeptha Curtis, MD, found that concerns about possible overuse of implantable cardioverter defibrillators, and a federal investigation, may have led to a recent drop in their use. But due to this investigation, did providers avoid ICD devices in patients who really needed them? Read the full paper in JAMA. Additionally, he looked at the correlation of financial penalties on readmission rates, outcomes for patients with healthcare-associated infections, and improving heart failure patient survival and quality of life by using a battery-operated pump and neurohormonal blockade (NHB) drug therapy.
Currently, Desai, Tariq Ahmad, MD, MPH, FACC; and F. Perry Wilson, MD, MSCE, serve as co-principal investigators on the Risk EValuation And Its Impact on ClinicAL Decision Making and Outcomes in Heart Failure (REVEAL HF) trial at Yale New Haven Hospital aiming to improve clinical outcomes for patient with heart failure.
“The fundamental question is, how do you make things better for the patients that we serve?” Desai said.
He is pleased with his winding career path and with his choice to return to Connecticut.
“I love Connecticut. I love this area. This is home for me along with my wife and three children,” said Desai. “That said, I think my past highlights is to go where you can have impact. And so if you feel like you can really do something special for a community, place, or health system, go there. But if I have my way, I'd be here for a long time.”
The Section of Cardiovascular Medicine shares in the academic mission of one of the world’s leading centers in biomedical research. To learn more about Desai’s work and the Section of Cardiovascular Medicine, visit Cardiovascular Medicine.