R Sacha Bhatia

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (13)109.89 Total impact

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    ABSTRACT: This study sought to prospectively study the impact of an appropriate use criteria (AUC)-based educational intervention on outpatient transthoracic echocardiography (TTE) ordering by physicians-in-training.
    JACC. Cardiovascular imaging. 08/2014;
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    ABSTRACT: Hospital admission rates for patients with heart failure (HF) presenting for emergency department (ED) care vary, and the implications of direct discharge home from the ED are unknown. We examined whether patients treated in hospitals with low admission rates exhibit higher rates of repeat ED visits, hospital readmissions and death.
    BMJ quality & safety 07/2014; · 2.39 Impact Factor
  • David M Dudzinski, R Sacha Bhatia, Rory B Weiner
    JAMA Internal Medicine 07/2014; 174(7):1195-1196. · 10.58 Impact Factor
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    ABSTRACT: We previously demonstrated that an Appropriate Use Criteria (AUC)-based educational intervention reduced inappropriate transthoracic echocardiograms (TTE) on an inpatient medical service. Whether improved TTE ordering is sustained after discontinuation of the intervention is unknown. We conducted a prospective, time series analysis of an educational intervention designed to reduce inappropriate TTE. Ordering patterns during the intervention were compared with a preintervention control period and a postintervention period. The goal of the present analysis was to determine the TTE ordering patterns after discontinuation of the educational intervention. The primary outcome was the proportion of inappropriate TTEs. Using the 2011 AUC 99.2% of all TTEs were classifiable. Compared to the control, there was a 26% reduction in the number of TTEs ordered per day during the intervention (3.9 vs. 2.9 TTEs, P < 0.001), but no significant difference between the intervention and postintervention periods (2.9 vs. 3.1, P = 0.23). The intervention produced a decrease in the inappropriate TTE rate and an increase in the appropriate TTE rate. Compared to the intervention, in the postintervention period the rate of inappropriate TTEs increased (5% vs. 11%, P = 0.01) and appropriate TTEs decreased (93% vs. 86%, P = 0.008). The postintervention rate of inappropriate TTEs was similar to the preintervention control period (11% vs. 13%, P = 0.23). Following completion of an AUC-based educational intervention the proportion of inappropriate TTEs increased to the preintervention level. The long-term success of an intervention designed to improve appropriate utilization of TTE requires a sustained effort of education and feedback.
    Echocardiography 01/2014; · 1.26 Impact Factor
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    ABSTRACT: OBJECTIVES: This study sought to prospectively study the impact of an appropriate use criteria (AUC)-based educational intervention on transthoracic echocardiography (TTE) ordering among house staff on the inpatient general internal medicine service at an academic medical center. BACKGROUND: AUC for TTE were developed in response to concerns about inappropriate use of TTE. To date, educational interventions based on the AUC to reduce inappropriate use of TTE have not been prospectively studied. METHODS: A prospective, time series analysis of an educational intervention was conducted and then compared with TTE ordering on the same medical service during a control period. The intervention consisted of: 1) a lecture to house staff on the 2011 AUC for TTE; 2) a pocket card that applied the AUC to common clinical scenarios; and 3) biweekly e-mail feedback regarding ordering behavior. TTE ordering was tracked over the intervention period on a daily basis and feedback reports were e-mailed at 2-week intervals. The primary outcome was the proportion of inappropriate and appropriate TTE ordered during the intervention period. RESULTS: Of all TTEs ordered in the control and study periods, 99% and 98%, respectively, were classifiable using the 2011 AUC. During the study period, there was a 26% reduction in the number of TTE ordered per day compared with the number ordered during the control period (2.9 vs. 3.9 TTE, p < 0.001). During the study period, the proportion of inappropriate TTE was significantly lower (5% vs. 13%, p < 0.001) and the proportion of appropriate TTE was significantly higher (93% vs. 84%, p < 0.001). CONCLUSIONS: A simple educational intervention produced a significant reduction in the proportion of inappropriate TTE and increased the proportion of appropriate TTE ordered on an inpatient academic medical service. This study provides a practical approach for using the AUC to reduce the number of inappropriate TTE. Further study in other practice environments is warranted.
    JACC. Cardiovascular imaging 04/2013; · 14.29 Impact Factor
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    ABSTRACT: The purpose of this study was to examine utilization and growth in echocardiography among the general population of Ontario between 2001 and 2009. The age- and sex-adjusted rates of echocardiography grew from 39.1 per 1,000 persons in 2001 to 59.9 per 1,000 persons in 2009, for an annual rate of increase of 5.5%. Repeat echocardiograms increased at a rate of 10.6% per year and accounted for 25.3% of all procedures in 2009 as compared to 18.5% in 2002. While significant increases in echocardiography utilization were observed, opportunities may exist to improve the clinical utility of the echocardiograms performed in Ontario.
    JACC. Cardiovascular imaging 04/2013; 6(4):515-22. · 14.29 Impact Factor
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    ABSTRACT: BACKGROUND: The 2008 appropriate use criteria (AUC) for stress echocardiographic (SE) examinations were revised in 2011 to cover a wider range of scenarios of use. Data comparing the 2008 and 2011 AUC for SE are limited. METHODS: A retrospective chart review of SE studies performed at an academic medical center was conducted, and ordering of SE studies was assessed using the 2008 and 2011 AUC. RESULTS: A total of 252 consecutive SE studies performed in 2011 were reviewed. The 2008 AUC classified 126 SE studies (50%), and the 2011 AUC classified 221 SE studies (88%) (P < .001). Of all SE studies, 106 (42%) were performed as part of evaluations for noncardiac solid-organ transplantation. The majority of these studies (79%) were classified as inappropriate using the 2011 AUC and were not classifiable using the 2008 AUC. Of the 146 SE studies performed for other reasons, 69% were appropriate and 22% were inappropriate using the 2011 AUC. Inappropriate SE studies for both the general nontransplant and noncardiac solid-organ transplantation populations were nearly exclusively ordered for perioperative assessment with normal functional capacity. The SE studies that remained unclassified by the 2011 AUC were related to the assessment of specialized cardiac conditions, including hypertrophic cardiomyopathy and follow-up after heart transplantation. CONCLUSIONS: The 2011 AUC classify a significantly greater proportion of SE studies compared with the 2008 AUC. Most of the reclassified SE studies using the 2011 AUC were inappropriate and were ordered for perioperative assessments in patients with normal functional capacity.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2013; · 2.98 Impact Factor
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    ABSTRACT: The 2007 Appropriate Use Criteria (AUC) for echocardiography was revised in 2011 to cover a wider range of scenarios of use. Previous studies of the 2007 AUC found a relatively large number of unclassified transthoracic echocardiograms (TTEs). We conducted a retrospective chart review comparing TTE usage in three clinical environments: academic inpatient, academic outpatient, and community outpatient. We assessed the TTE ordering behavior using both the 2007 and 2011 AUC. We reviewed 150 consecutive TTEs performed in 2011 in each of the three practice settings (total 450). Using the 2007 AUC, 347 TTEs (77%) were classifiable, and, using the 2011 AUC, 441 TTEs (98%) were classifiable (P < .001). Of the classified studies, the percentage of appropriate TTEs using the 2007 AUC was 83% and using the 2011 AUC was 71% (P < .001). Using the 2007 and 2011 AUC, the percentage of inappropriate TTEs was 17% and 22% (P = .14), and the percentage of uncertain TTEs was 0% and 7% (P < .001), respectively. The rate of inappropriate studies was greatest in the outpatient academic medical center (30%), followed by the outpatient community health center (21%) and the inpatient academic medical center (14%; P = .004). The 2011 AUC classified a significantly greater proportion of TTEs than the 2007 AUC across a variety of practice settings. The rate of appropriate TTEs was lower using the 2011 AUC, and the appropriateness ratings varied by clinical setting. These findings suggest that the expanded AUC offer an opportunity for improvement in TTE usage.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2012; 25(11):1162-9. · 2.98 Impact Factor
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    ABSTRACT: The 2007 appropriate use criteria (AUC) for echocardiography were revised in 2011 to cover a wider range of scenarios of use. The aim of this study was to compare the 2011 AUC with the 2007 AUC to determine if the 2011 AUC better classify transesophageal echocardiography (TEE) and to determine the impact of the 2011 AUC on the rates of appropriate and inappropriate TEE at an academic medical center. A retrospective chart review was conducted to examine inpatient and outpatient TEE utilization. TEE ordering behavior was compared using both the 2007 and 2011 AUC, and studies were classified as appropriate, uncertain, inappropriate, or not classifiable. We reviewed 202 consecutive transesophageal echocardiographic studies (154 inpatient, 48 outpatient) performed in 2011. Using the 2007 AUC, 166 studies (82%) were classifiable, and using the 2011 AUC, 199 (99%) were classifiable (P < .001). Among the classified studies, the percentage of appropriate studies using the 2007 AUC was 94% and using the 2011 AUC was 95% (P = .68). Using 2007 and 2011 AUC, the percentages of inappropriate studies were 0% and 4% (P = .02), and the percentages of uncertain studies were 6% and 1% (P = .006), respectively. The 2011 AUC classify a significantly greater proportion of transesophageal echocardiographic studies than the 2007 AUC. The rate of inappropriate studies using the 2011 AUC is higher than when using the 2007 AUC. These findings suggest that the expanded AUC offer an opportunity for improvement in the utilization of TEE.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2012; 25(11):1170-5. · 2.98 Impact Factor
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    R Sacha Bhatia
    Canadian Medical Association Journal 08/2011; 184(7):E337-8. · 6.47 Impact Factor
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    ABSTRACT: The decision to anti-coagulate patients with heart failure (HF) is a difficult one, with limited data available to support clinical judgment. Thromboembolic complications, both arterial (stroke) and venous (deep vein thrombosis and pulmonary embolism), remain a significant cause of mortality and morbidity in this population. The pathophysiology of thrombogenesis in HF may be contextualized in the classic triad of stasis, endothelial dysfunction and hypercoagulability. Dilated cardiac chambers, reduced systolic function, and left ventricular aneurysm or thrombus have been suggested as potential contributing factors. HF is associated with activation of inflammatory and neuroendocrine pathways, leading to endothelial dysfunction and a prothrombotic state with dysregulated platelets and activation of the coagulation cascade. The epidemiology of thromboembolic events in HF is poorly defined. Most studies are retrospective and include patients with concurrent atrial fibrillation. The current body of health outcomes research is reviewed to identify the specific etiological factors, prevalence, and impact of thromboembolic events in this patient population. Conflicting analyses exist regarding the risks and benefits of prophylaxis in HF. The data surrounding several classes of therapeutic agents are synthesized. Recent clinical trials on anticoagulation and HF are reviewed, including WATCH, WASH, and WARCEF. The absence of compelling clinical trial data leaves many unanswered questions regarding systemic anticoagulation in patients with HF.
    Cardiovascular & hematological agents in medicinal chemistry 08/2009; 7(3):193-7.
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    ABSTRACT: The importance of heart failure with preserved ejection fraction is increasingly recognized. We conducted a study to evaluate the epidemiologic features and outcomes of patients with heart failure with preserved ejection fraction and to compare the findings with those from patients who had heart failure with reduced ejection fraction. From April 1, 1999, through March 31, 2001, we studied 2802 patients admitted to 103 hospitals in the province of Ontario, Canada, with a discharge diagnosis of heart failure whose ejection fraction had also been assessed. The patients were categorized in three groups: those with an ejection fraction of less than 40 percent (heart failure with reduced ejection fraction), those with an ejection fraction of 40 to 50 percent (heart failure with borderline ejection fraction), and those with an ejection fraction of more than 50 percent (heart failure with preserved ejection fraction). Two groups were studied in detail: those with an ejection fraction of less than 40 percent and those with an ejection fraction of more than 50 percent. The main outcome measures were death within one year and readmission to the hospital for heart failure. Thirty-one percent of the patients had an ejection fraction of more than 50 percent. Patients with heart failure with preserved ejection fraction were more likely to be older and female and to have a history of hypertension and atrial fibrillation. The presenting history and clinical examination findings were similar for the two groups. The unadjusted mortality rates for patients with an ejection fraction of more than 50 percent were not significantly different from those for patients with an ejection fraction of less than 40 percent at 30 days (5 percent vs. 7 percent, P=0.08) and at 1 year (22 percent vs. 26 percent, P=0.07); the adjusted one-year mortality rates were also not significantly different in the two groups (hazard ratio, 1.13; 95 percent confidence interval, 0.94 to 1.36; P=0.18). The rates of readmission for heart failure and of in-hospital complications did not differ between the two groups. Among patients presenting with new-onset heart failure, a substantial proportion had an ejection fraction of more than 50 percent. The survival of patients with heart failure with preserved ejection fraction was similar to that of patients with reduced ejection fraction.
    New England Journal of Medicine 08/2006; 355(3):260-9. · 51.66 Impact Factor
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    ABSTRACT: LR: 20071115; CI: Copyright 2006; JID: 0255562; CIN: N Engl J Med. 2006 Oct 26;355(17):1829; author reply 1830-1. PMID: 17072999; CIN: N Engl J Med. 2006 Oct 26;355(17):1829-30; author reply 1830-1. PMID: 17072998; CIN: N Engl J Med. 2006 Jul 20;355(3):308-10. PMID: 16855273; CIN: Evid Based Med. 2006 Dec;11(6):185. PMID: 17213179; CIN: N Engl J Med. 2006 Oct 26;355(17):1828; author reply 1830-1. PMID: 17065647; CIN: ACP J Club. 2006 Nov-Dec;145(3):78. PMID: 17080990; CIN: N Engl J Med. 2006 Oct 26;355(17):1828-9; author reply 1830-1. PMID: 17073000; ppublish
    The New England journal of medicine. 01/2006; 355(3):260-269.