Bio

Bio


Alex Sandhu, MD, MS is a cardiology fellow and health services researcher. He graduated from the 7-year combined BA-MD program at Northwestern Feinberg School of Medicine, then completed internal medicine residency at Stanford University, spending 16 weeks in at Makerere Hospital in Uganda as part of the Global Health track. He completed a Masters in Health Services Research at Stanford University before starting cardiology fellowship.

His clinical interests include outcomes research, heart failure, global health cardiology, and evidence-based medicine. In his free time, he enjoys playing soccer and learning to surf.

Clinical Focus


  • Cardiology
  • Outcomes research
  • Cardiovascular Disease

Academic Appointments


  • Instructor, Medicine

Professional Education


  • Residency: Stanford University Internal Medicine Residency CA
  • Fellowship: Stanford University Advanced Heart Failure and Transplant Fellowship (2020) CA
  • Board Certification: National Board of Echocardiography, Echocardiography (2019)
  • Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2019)
  • Fellowship: Stanford University Cardiovascular Medicine Fellowship (2019) CA
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2014)
  • Internship: Stanford University Internal Medicine Residency (2012) CA
  • Medical Education: Northwestern University Feinberg School of Medicine (2011) IL
  • Residency, Stanford University, Internal Medicine (2014)
  • Master of Science, Stanford University, Health Services Research (2016)

Publications

All Publications


  • Comparison of the change in heart failure readmission and mortality rates between hospitals subject to hospital readmission reduction program penalties and critical access hospitals. American heart journal Sandhu, A. T., Heidenreich, P. A. 2018; 209: 63–67

    Abstract

    BACKGROUND: The Hospital Readmission Reduction Program (HRRP), announced in 2010, penalizes hospitals with high readmissions for multiple conditions including heart failure.METHODS: We compared heart failure readmission and mortality rates in hospitals exposed to HRRP financial penalties with critical access hospitals (CAHs) not subject to the penalty between 2005 and 2016 using 3-year moving averages from Hospital Compare.RESULTS: After HRRP introduction, CAHs experienced a 0.60% annual decrease (95% CI: -0.61 to -0.59%) in heart failure readmissions. HRRP-exposed hospitals experienced an additional 0.13% annual decrease (95% CI: -0.14 to -0.12%) compared with CAHs. The association between HRRP penalties and mortality varied with model specifications.CONCLUSIONS: Using CAHs as a control group, we found the introduction of financial penalties was only associated with modest reductions in readmissions and an uncertain association with mortality. Cluster-randomized rollouts of health care policy interventions will allow us to better evaluate the impact of our interventions.

    View details for PubMedID 30685676

  • Association Between Offering Limited Left Ventricular Ejection Fraction Echocardiograms and Overall Use of Echocardiography. JAMA internal medicine Sandhu, A. T., Parizo, J., Moradi-Ragheb, N., Heidenreich, P. A. 2018

    View details for PubMedID 30039163

  • Cost-Effectiveness of Sacubitril-Valsartan in Patients Who Have Heart Failure With Reduced Ejection Fraction. Annals of internal medicine Sandhu, A. T., Ollendorf, D. A., Chapman, R. H., Pearson, S. D., Heidenreich, P. A. 2017; 166 (8): 607-608

    View details for DOI 10.7326/L17-0044

    View details for PubMedID 28418550

  • Cardiovascular Testing and Clinical Outcomes in Emergency Department Patients With Chest Pain. JAMA internal medicine Sandhu, A. T., Heidenreich, P. A., Bhattacharya, J. n., Bundorf, M. K. 2017

    Abstract

    Noninvasive testing and coronary angiography are used to evaluate patients who present to the emergency department (ED) with chest pain, but their effects on outcomes are uncertain.To determine whether cardiovascular testing-noninvasive imaging or coronary angiography-is associated with changes in the rates of coronary revascularization or acute myocardial infarction (AMI) admission in patients who present to the ED with chest pain without initial findings of ischemia.This retrospective cohort analysis used weekday (Monday-Thursday) vs weekend (Friday-Sunday) presentation as an instrument to adjust for unobserved case-mix variation (selection bias) between 2011 and 2012. National claims data (Truven MarketScan) was used. The data included a total of 926 633 privately insured patients ages 18 to 64 years who presented to the ED with chest pain without initial diagnosis consistent with acute ischemia.Noninvasive testing or coronary angiography within 2 days or 30 days of presentation.The primary end points were coronary revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) and AMI admission at 7, 30, 180, and 365 days. The secondary end points were coronary angiography and coronary artery bypass grafting in those who underwent angiography.The patients were ages 18 to 64 years with an average age of 44.4 years. A total of 536 197 patients (57.9%) were women. Patients who received testing (224 973) had increased risk at baseline and had greater risk of AMI admission than those who did not receive testing (701 660) (0.35% vs 0.14% at 30 days). Weekday patients (571 988) had similar baseline comorbidities to weekend patients (354 645) but were more likely to receive testing. After risk factor adjustment, testing within 30 days was associated with a significant increase in coronary angiography (36.5 per 1000 patients tested; 95% CI, 21.0-52.0) and revascularization (22.8 per 1000 patients tested; 95% CI, 10.6-35.0) at 1 year but no significant change in AMI admissions (7.8 per 1000 patients tested; 95% CI, -1.4 to 17.0). Testing within 2 days was also associated with a significant increase in coronary revascularization but no difference in AMI admissions.Cardiac testing in patients with chest pain was associated with increased downstream testing and treatment without a reduction in AMI admissions, suggesting that routine testing may not be warranted. Further research into whether specific high-risk subgroups benefit from testing is needed.

    View details for PubMedID 28654959

  • Coronary CT Angiography and Subsequent Risk of Myocardial Infarction NEW ENGLAND JOURNAL OF MEDICINE Sandhu, A. T., Maron, D. J. 2019; 380 (3): 299
  • Validity of Performance and Outcome Measures for Heart Failure. Circulation. Heart failure Patel, J., Sandhu, A., Parizo, J., Moayedi, Y., Fonarow, G. C., Heidenreich, P. A. 2018; 11 (9): e005035

    Abstract

    Background Numerous quality metrics for heart failure (HF) care now exist based on process and outcome. What remains unclear, however, is if the correct quality metrics are being emphasized. To determine the validity of certain measures, we compared correlations between measures and reliability over time. Measures assessed include guideline-recommended beta-blocker (BB), any BB, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker, mineralocorticoid receptor antagonist, and hydralazine/isosorbide dinitrate (in blacks) use among candidates, 30-day mortality, 1-year mortality, and 30-day readmission. Methods and Results This was an observational cohort analysis using chart review and electronic resources for 55735 patients from 102 Veterans Affairs medical centers hospitalized with HF from 2008 to 2013. Assessments of convergent validity and reliability were performed. Significant correlations were found between in-hospital rates of ACE inhibitor use and the following measures: BB use, 30-day mortality, and 1-year mortality. Guideline-recommended BB use was also significantly correlated with mineralocorticoid receptor antagonists, 30-day mortality, and 1-year mortality. There was no correlation between 30-day readmission rates and any therapy or mortality. Measure reliability over time was seen for guideline-recommended BBs ( r=0.57), mineralocorticoid receptor antagonists ( r=0.50), 30-day mortality ( r=0.29), and 1-year mortality ( r=0.31). ACE inhibitor and readmission rates were not reliable measures over time. Conclusions BB use, ACE inhibitor use, mortality, and mineralocorticoid receptor antagonist use are valid measures of HF quality. Thirty-day readmission rate did not seem to be a valid measure of HF quality of care. If the goal is to identify high-quality HF care, the emphasis on decreasing readmission rates might be better directed towards improving usage of the recommended therapies.

    View details for PubMedID 30354367

  • Heart failure management with ambulatory pulmonary artery pressure monitoring. Trends in cardiovascular medicine Sandhu, A. T., Heidenreich, P. A. 2018; 28 (3): 212–19

    Abstract

    Remote monitoring strategies have been developed to improve ambulatory care of heart failure patients and reduce heart failure hospitalizations. This article evaluates the CardioMEMS device, an implantable wireless pulmonary artery pressure monitor. We provide a historical review of remote monitoring in heart failure along with an in-depth analysis of the rationale, evidence, and limitations of the CardioMEMS device.

    View details for PubMedID 28988604

  • Determinants of Raised Blood Pressure in Urban Uganda: A Community-Based Case-Control Study. Ethnicity & disease Chin, J. H., Twinobuhungiro, A., Sandhu, A., Hootsmans, N., Kayima, J., Kalyesubula, R. 2017; 27 (1): 15-20

    Abstract

    Rapid urbanization is changing the epidemiology of non-communicable diseases in sub-Saharan Africa. We aimed to identify the determinants of raised blood pressure in urban Uganda to highlight targets for preventive interventions.Case-control.Three community-based sites in Kampala, the capital of Uganda.Participants were eligible to enroll if they were aged ≥18 years and not pregnant.450 cases with raised blood pressure were frequency matched by sex and age to 412 controls. Unconditional logistic regression was used to evaluate the association of socio-demographic, lifestyle, anthropometric, and laboratory variables with the outcome of raised blood pressure. Cases currently treated with antihypertensive medication and cases not treated with antihypertensive medication were analyzed separately.Significantly increased odds of raised blood pressure were associated with overweight body mass index (BMI) (25 kg/m(2) ≤ BMI < 30 kg/m(2)), obese BMI (BMI ≥ 30 kg/m(2)) and hemoglobin A1c ≥ 6.5%. Significantly decreased odds of raised blood pressure were associated with moderate-to-vigorous work-related physical activity of >4 hours/week. No significant associations were found between raised blood pressure and marital status, education level, car or flush toilet ownership, dietary habits, alcohol consumption, smoking habits, moderate-to-vigorous leisure-related physical activity > 4 hours/week, waist-to-hip ratio, or total cholesterol levels.Targeted interventions are needed to address the key modifiable risk factors for raised blood pressure identified in this study, namely elevated BMI and regular physical activity, in order to reduce the burden of cardiovascular disease in urban Uganda.

    View details for DOI 10.18865/ed.27.1.15

    View details for PubMedID 28115817

  • Using Commercial Programs for Lifestyle Intervention: Not Reinventing the Wheel. Journal of the American College of Cardiology Maron, D. J., Sandhu, A. T. 2017; 70 (3): 328–30

    View details for PubMedID 28705313

  • Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction ANNALS OF INTERNAL MEDICINE Sandhu, A. T., Ollendorf, D. A., Chapman, R. H., Pearson, S. D., Heidenreich, P. A. 2016; 165 (10): 681-?

    Abstract

    Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction.To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure.Markov decision model.Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables.Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less.Lifetime.Societal.Treatment with sacubitril-valsartan or lisinopril.Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios.The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure.Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained.The benefit of sacubitril-valsartan is based on a single clinical trial.Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure.U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.

    View details for DOI 10.7326/M16-0057

    View details for Web of Science ID 000387970500012

    View details for PubMedID 27571284

  • CardioMEMS HF for the Management of Heart Failure-Effectiveness and Value JAMA INTERNAL MEDICINE Ollendorf, D. A., Sandhu, A. T., Pearson, S. D. 2016; 176 (10): 1551-1552
  • Cost-Effectiveness of Implantable Pulmonary Artery Pressure Monitoring in Chronic Heart Failure JACC-HEART FAILURE Sandhu, A. T., Goldhaber-Fiebert, J. D., Owens, D. K., Turakhia, M. P., Kaiser, D. W., Heidenreich, P. A. 2016; 4 (5): 368-375

    Abstract

    This study aimed to evaluate the cost-effectiveness of the CardioMEMS (CardioMEMS Heart Failure System, St Jude Medical Inc, Atlanta, Georgia) device in patients with chronic heart failure.The CardioMEMS device, an implantable pulmonary artery pressure monitor, was shown to reduce hospitalizations for heart failure and improve quality of life in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) trial.We developed a Markov model to determine the hospitalization, survival, quality of life, cost, and incremental cost-effectiveness ratio of CardioMEMS implantation compared with usual care among a CHAMPION trial cohort of patients with heart failure. We obtained event rates and utilities from published trial data; we used costs from literature estimates and Medicare reimbursement data. We performed subgroup analyses of preserved and reduced ejection fraction and an exploratory analysis in a lower-risk cohort on the basis of the CHARM (Candesartan in Heart failure: Reduction in Mortality and Morbidity) trials.CardioMEMS reduced lifetime hospitalizations (2.18 vs. 3.12), increased quality-adjusted life-years (QALYs) (2.74 vs. 2.46), and increased costs ($176,648 vs. $156,569), thus yielding a cost of $71,462 per QALY gained and $48,054 per life-year gained. The cost per QALY gained was $82,301 in patients with reduced ejection fraction and $47,768 in those with preserved ejection fraction. In the lower-risk CHARM cohort, the device would need to reduce hospitalizations for heart failure by 41% to cost <$100,000 per QALY gained. The cost-effectiveness was most sensitive to the device's durability.In populations similar to that of the CHAMPION trial, the CardioMEMS device is cost-effective if the trial effectiveness is sustained over long periods. Post-marketing surveillance data on durability will further clarify its value.

    View details for DOI 10.1016/j.jchf.2015.12.015

    View details for PubMedID 26874380

  • Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program RESPONSE ANNALS OF INTERNAL MEDICINE Sandhu, A. T., Dudley, R. A., Kazi, D. S. 2016; 164 (8): 571-572

    View details for DOI 10.7326/L16-0007

    View details for Web of Science ID 000374257900024

    View details for PubMedID 27089078

  • Sacubitril-Valsartan for the Treatment of Heart Failure: Effectiveness and Value. JAMA internal medicine Ollendorf, D. A., Sandhu, A. T., Pearson, S. D. 2016; 176 (2): 249-250

    View details for DOI 10.1001/jamainternmed.2015.7661

    View details for PubMedID 26720832

  • Immune thrombocytopenia Hospital Medicine Clinics Ma, I., Sandhu, A. T. 2016; 6 (1): 53-66
  • A Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program ANNALS OF INTERNAL MEDICINE Sandhu, A. T., Dudley, R. A., Kazi, D. S. 2015; 163 (6): 401-?

    Abstract

    In 2014, the American Board of Internal Medicine (ABIM) substantially increased the requirements and fees for its maintenance-of-certification (MOC) program. Faced with mounting criticism, the ABIM suspended certain content requirements in February 2015 but retained the increased fees and number of modules. An objective appraisal of the cost of MOC would help inform upcoming consultations about MOC reform.To estimate the total cost of the 2015 version of the MOC program ("2015 MOC") and the incremental cost relative to the 2013 version ("2013 MOC").Decision analytic model.Published literature.All ABIM-certified U.S. physicians.10 years (2015 to 2024).Societal.2015 MOC.Testing costs (ABIM fees) and time costs (monetary value of physician time).Internists will incur an average of $23 607 (95% CI, $5380 to $66 383) in MOC costs over 10 years, ranging from $16 725 for general internists to $40 495 for hematologists-oncologists. Time costs account for 90% of MOC costs. Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC. This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs.Costs are sensitive to time spent on MOC and MOC credits obtainable from current continuing education activities.Precise estimates of time required for MOC are not available.The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time. A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study.University of California, San Francisco, and the U.S. Department of Veterans Affairs.

    View details for DOI 10.7326/M15-1011

    View details for Web of Science ID 000361365900014

    View details for PubMedID 26216046

  • Telomere length in patients with systemic lupus erythematosus and its associations with carotid plaque RHEUMATOLOGY Skamra, C., Romero-Diaz, J., Sandhu, A., Huang, Q., Lee, J., Pearce, W., McPherson, D. D., Sutton-Tyrrell, K., Pope, R., Ramsey-Goldman, R. 2013; 52 (6): 1101-1108

    Abstract

    To evaluate telomere length (TL) between patients with SLE and healthy controls and to test if TL is associated with carotid plaque.A pilot study of 154 patients with SLE and 152 controls was performed from the SOLVABLE (Study of Lupus Vascular and Bone Long-Term Endpoints) cohort. Demographic and cardiovascular disease (CVD) factors were collected at baseline. The presence or absence of plaque was evaluated by B-mode US. Genomic DNA was isolated from whole peripheral blood. TL was quantified using real-time quantitative PCR.SLE women had a short TL compared with healthy controls (4.57 vs 5.44 kb, P = 0.03). SLE women showed shorter TL than controls across all age groups: <35 years (4.38 vs 6.37 kb), 35-44 years (4.52 vs 5.30 kb), 45-54 years (4.77 vs 5.68 kb) and ≥55 years (4.60 vs 4.71 kb). Among patients with SLE and carotid plaque there was a trend towards shorter TL at a younger age and it was significantly lower in the 35- to 44-year age group when compared with controls (P = 0.025). Multiple logistic regression analysis indicated a risk of carotid plaque with older age [odds ratio (OR) 1.09; 95% CI 1.06, 1.12] but not with TL (OR 1.05; 95% CI 0.97, 1.13).SLE women had significantly shorter TL than controls. SLE women trended towards shorter TL at a younger age. When carotid plaque was identified, the younger SLE women had shorter TL. Only older age but not shorter TL was independently associated with carotid plaque. Additional studies are needed to confirm if TL is a novel biomarker for cardiovascular disease in SLE.

    View details for DOI 10.1093/rheumatology/kes424

    View details for Web of Science ID 000319460000018

    View details for PubMedID 23382361

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