Harlan Krumholz
Section of Cardiovascular Medicine
Department of Internal Medicine
harlan.krumholz@yale.edu

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Research
My research has focused on determining optimal clinical strategies and identifying opportunities for improvement in the prevention, treatment and outcome of cardiovascular disease with emphasis on older populations. Using methods of clinical epidemiologyand health services research, I have sought to illuminate the balance of risks, benefits and costs of specific clinical approaches. The research efforts are intended to provide critical information to improve the quality of health care, monitor changes over time, and guide decisions about the allocation of scarce health care resources. For example, a series of our articles on thrombolytic therapy have shown the following: the majority of elderly patients are ineligible based on their electrocardiographicpresentation; among the eligible, the reduction in the risk of death far exceeds the additional risk of complications with increasing age; the benefit of thrombolytic therapy in the elderly is achieved at a cost that is comparable to other accepted interventions; and, despite the advantages of thrombolytic therapy in the elderly, about a quarter of ideal candidates do not receive the treatment.

Several investigations have evaluated the therapeutic effectiveness of coronary revascularization, aspirin, heparin, and beta-blockers in older patients. Other studies have evaluated the quality of care for patients with acute myocardial infarction, unstable ischemic syndromes, and heart failure, respectively. We have also sought to understand the prognostic importance of non-traditional risk factors such as emotional support and baseline functional status. Several projects are evaluating the benefit of patient education programs. Recent studies are aimed at examining the impact of managed care on the care and outcomes of elderly patients with an acute myocardial infarction. These projects are facilitated by innovative collaborations with Yale-New Haven Hospital Center for Outcomes Research and Evaluation, Qualidigm, the Centers for Medicare & Medicaid Services, and managed care organizations.