Robert L. McNamara

Associate Professor of Medicine (Cardiology)
Director, Echocardiography
Director, Cardiology Fellowship Program
Section of Cardiovascular Medicine

Research Interests

Application of Evidence-Based Medicine to Improving Outcomes in Patients with Cardiovascular Disease

My research has centered on evaluating the use of evidence-based medicine on the diagnosis and management of patients with cardiovascular disease. I have sought to identify areas in clinical medicine with significant variation in care, use various methodologies to obtain and analyze the different strategies and outcomes, and provide a sound base of evidence on which to recommend clinical decisions. The methodologies include primary data collection, secondary data analysis, synthesis of results of various studies into clinically useful forms such as meta-analyses and cost-effectiveness analysis, qualitative studies, establishing clinical practice guidelines and data standards, and promoting quality assurance and improvement. Current projects include evaluating differences in the treatment and outcome of patients with myocardial infarction between the US and the UK, studying ways to increase the application of guideline-proven therapies in patients with acute myocardial infarction, and establishing quality performance standards for noninvasive cardiac imaging.

Selected Publications

McNamara RL, Lima JAC, Whelton PK, Powe NR. Identification of cardiovascular sources of emboli to guide clinical management after stroke: A cost-effectiveness analysis. Annals of Internal Medicine 1997;127:775-787.

McNamara RL, Powe NR, Shaffer T, Thiemann D, Weller W, Anderson G. Capitation for cardiologists: Accepting risk for coronary artery disease under managed care. Am J Cardiol 1998;82:1178-1182.

McNamara RL, Lima JAC, Whelton PK, Powe NR. Costs and benefits of echocardiography strategies after stroke. Cardiology Review 1998;15(12):17-21.

Segal JB, McNamara RL, Miller MR, Kim N, Robinson K, Yu D, Goodman SN, Powe NR, Bass EB. Prevention of thromboembolism in atrial fibrillation: A meta-analysis of trials of anticoagulants and antiplatelet drugs. J Gen Intern Med 2000;15:56-67.

Miller MR, McNamara RL, Segal JB, Kim N, Robinson K, Goodman SN, Powe NR, Bass EB. Efficacy of agents for pharmacological conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials. The J Fam Pract 2000;49:1033-1046.

McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, Robinson KA, Powe NR. Evidence Report on Management of New Onset Atrial Fibrillation. (Prepared by The Johns Hopkins Evidence-based Practice Center under Contract No. 290-97-00006.) AHRQ Publication No. AHRQ 01-E026. Rockville, MD. January 2001.

McNamara RL, Powe NR, Thiemann D, Shaffer T, Weller W, Anderson G. Specialty of principal care physician and Medicare expenditures in patients with coronary artery disease: Impact of comorbidity and severity. Am J Manag Care 2001;7:261-266.

Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Levy S, McNamara RL, Prystowsky EN, Wann SL, Wyse DG. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology.?J Am Coll Cardiol 2001;38(4):1231-1266?Eur Heart J 2001;22(20):1852-923?Circulation 2001;104(17):2118-50.

Ding J, Diez Roux AV, Nieto FJ, McNamara RL, Hetmanski JB, Taylor HA, Jr., Tyroler HA. Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities Study. Am Heart J. 2003;146:459-64.

Babayan ZV, McNamara RL, Nagajothi N, Kasper EK, Armenian HK, Powe NR, Baughman KL, Lima JAC. Predictors of Cause-Specific Hospital Readmissions in Patients with Congestive Heart Failure. Clin Cardiol 2003;26:411-418.

McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of Atrial Fibrillation: Review of the Evidence for the Role of Pharmacologic Therapy, Electrical Cardioversion, and Echocardiography. Ann Intern Med. 2003;139:1018-1033.

Snow V, Weiss KB, LeFevre M, McNamara RL, Bass E, Green LA, Michl K, Owens DK, Susman J, Allen DI, Mottur-Pilson C. Management of Newly Detected Atrial Fibrillation: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003;139:1009- 1017.

McNamara RL, Brass LM, Drozda JP Jr, Go AS, Halperin JL, Kerr KR, Levy S, Malenka DJ, Mittal S, Pelosi F Jr, Rosengerg Y, Stryer D, Wyse DG. ACC/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with atrial fibrillation: A report of the ACC/AHA Task Force on Clinical Data Standards (Writing Committee to Develop Data Standards for Atrial Fibrillation). ?Circulation. 2004;109:3223-3243?J Am Coll Cardiol 2004;44(2):475-495.

Magid DJ, Wang Y, Herrin J, McNamara RL, Bradley EH, Curtis JP, Pollack CV, French WJ, Blaney ME, Krumholz HM. Relationship Between Time of Day, Day of Week, Timeliness of Reperfusion, and In-Hospital Mortality for Patients With Acute ST-Segment Elevation Myocardial Infarction. JAMA. 2005;294:803-812.

McNamara RL, Herrin J, Bradley EH, Portnay EL, Curtis J, Wang Y, Magid D, Blaney M, Krumholz HM. Hospital Improvement in Time to Reperfusion in Patients with Acute Myocardial Infarction, 1999-2002. J Am Coll Cardiol. 2006;47:45-47.

Bradley EH, Roumanis SA, Radford MJ, Webster TR, McNamara RL, Mattera JA, Barton, BA, Berg DN, Portnay EL, Moscovitz H, Parkosewich J, Holmboe ES, Blaney M, Krumholz HM. Achieving door-to-balloon times that meet quality guidelines. How do successful hospitals do it? J Am Coll Cardiol 2005; 46:1236-1241.

Nallamothu BK, Wang Y, Magid DJ, McNamara RL, Herrin J, Pollack CV, Bradley EH, Bates ER, Krumholz HM. Relationship between Hospital Specialization with Primary Percutaneous Coronary Intervention and Clinical Outcomes in ST-Elevation Myocardial Infarction: A National Registry of Myocardial Infarction-4 Analysis. Circulation. 2006;113:222-229.

Bradley EH, Curry LA, Webster TR, Mattera JA, Roumanis SA, Radford MJ, McNamara RL, Barton BA, Berg DN, Krumholz HM. Achieving Rapid Door-To-Balloon Times: How Top Hospitals Improve Complex Clinical Systems. Circulation. 2006;113:1079-1085.

Bradley EH, Herrin J, Elbel B, McNamara RL, Magid DJ, Nallamathou BK, Wang Y, Normand ST, Spertus JA, Krumholz HM. Hospital quality for Acute myocardial infarction: Correlation among hospital measures and relationship with short-term mortality. JAMA. 2006; 296:72-78.

Mena C, Wencker D, Krumholz HM, McNamara RL. Detection of heart transplant rejection in adults by echocardiographic diastolic indices: A quality review of the literature. J Am Soc of Echocardiogr 2006; 19:1295-1300.

Douglas P, Iskandrian AE, Krumholz HM, Gillam L, Hendel R Jollis J, Peterson E, Chen J, Masoudi F, Mohler E, McNamara RL, Patel M, Spertus J. Achieving Quality in Cardiovascular Imaging: Proceedings From the American College of Cardiology–Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging. J Am Coll Cardiol 2006; 48 2141-2151.

Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, Roumanis SA, Curtis JP, Nallamathou BK, Magid DJ, McNamar RL, Parkosewich J, Loeb JM, Krumholz HM. Reducing door-to-balloon times in patients with ST segment elevation myocardial infarction. New Eng J Med 2006; 355:2308-2320.

McNamara RL, Herrin J, Wang Y, Curtis J, Bradley EH, Magid DJ, Rathore S, Nallamothu BK, Peterson E, Blaney M, Frederick P, Krumholz HM. Impact of Delay in Door-to-Needle Time on Mortality in Patients with ST-Segment Myocardial Infarction. Am J of Cardiol 2007 Oct 15;100(8):1227-32.

Austin BA, Wang Y, Smith GL, Vaccarino V, Krumholz HM, McNamara RL. Systolic Function as a Predictor of Mortality and Quality of Life in Long-term Survivors with Heart Failure. Clinical Cardiology 2008 Mar 31(3):119-24

Pearte CA, Myerson M, Coresh J, McNamara RL, Rosamond W, Taylor H, Manolio TA. Atherosclerosis Risk In Communities Study. Variation and temporal trends in the use of diagnostic testing during hospitalization for acute myocardial infarction by age, gender, race, and geography. Am J of Cardiology 2008; 101(9):1219-25

Estes NA 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJ, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 2008; 117(8):1101-20. J Am Coll of Cardiol 2008; 51(8):865-84.

Education:	B.S., University of Notre Dame, 1986 M.D., Washington University School of Medicine, 1991 M.H.S., Johns Hopkins School of Public Health, 1997
Training:	Medical Residency: Hospital of the University of Pennsylvania, 1991-1993 Cardiovascular Fellowship: Hospital of the University of Pennsylvania, 1993-1995; Johns Hopkins Medical Institutions 1995-1997

Contact

Campus Address
Department of Internal Medicine
Section of Cardiovascular Medicine
Yale University
School of Medicine
Box 208017
New Haven, CT
06520-8017

E-mail
robert.mcnamara@yale.edu

Telephone
203.785.4114