About

Alexander Craig Fanaroff, MD, MHS, is an Assistant Professor of Medicine in Cardiovascular Medicine at the Hospital of the University of Pennsylvania. He is an attending physician and a faculty member at the Cardiovascular Outcomes, Quality, and Evaluative Research Center. He also holds positions as a Senior Fellow at the Leonard Davis Institute for Health Economics and is an affiliated faculty member at several centers, including the Center for Health Incentives and Behavioral Economics/Penn Roybal Center, the Penn Institute for Translational Medicine and Therapeutics, and the Penn Palliative and Advanced Illness Research Center. Fanaroff's educational background includes an AB in English from Duke University (2007), an MD from Duke University School of Medicine (2011), and an MHS in Clinical Research from Duke University School of Medicine (2018). His research and clinical interests focus on cardiovascular outcomes, health economics, behavioral economics, and strategies to improve medication adherence and health behaviors. He is involved in various research projects and clinical trials aimed at advancing in-hospital mortality prediction, increasing medication adherence through gamification, and addressing health disparities in cardiovascular care.

Research topics

• Medicine
• Internal medicine
• Environmental health
• Endocrinology
• Demography
• Gerontology
• Surgery
• Cardiology

Selected publications

• Early discontinuation of long-term anticoagulation after surgical left atrial appendage occlusion

  The Annals of Thoracic Surgery · 2026-05-01

  article
  PublisherDOI

• Racial, ethnic, socioeconomic, and geographic inequities in catheter ablation for atrial fibrillation

  Heart Rhythm · 2026-01-25

  articleOpen access

  BACKGROUND: Catheter ablation is effective in the treatment of atrial fibrillation (AF), however, it requires a significant amount of resources that may not be available in all areas. OBJECTIVE: We sought to understand geographic, racial, ethnic, and socioeconomic differences in the utilization of catheter ablation for AF. METHODS: Medicare fee-for-service beneficiaries with a diagnosis of AF were identified from the Medicare Inpatient and Outpatient data files between 2016 and 2019. To study inequities in utilization, we generated Generalized Estimating Equations to model the association between ZIP code-level racial, ethnic, and socioeconomic composition and ZIP code-level catheter ablation rates among patients with AF. RESULTS: For each 10% increase in the percentage of patients who were dual-eligible for Medicaid (a marker of poverty) in a ZIP code, 275 fewer patients per 10,000 underwent AF ablation (P = .0003). After adjusting for dual-eligible status, for each 10% increase in the percentage of Black patients in a ZIP code, 618 fewer underwent AF ablation (P < .0001), whereas for each 10% increase in the percentage of Hispanic patients, 430 fewer underwent AF ablation (P = .002). CONCLUSION: There are significant inequities in utilization of AF ablation, associated with racial, ethnic, and socioeconomic differences. Inequitable utilization in marginalized groups of patients may generate and propagate inequities in health.

  PublisherDOI

• A pilot randomized clinical trial of gamification to increase medication adherence

  American Heart Journal · 2026-03-07

  articleOpen access1st authorCorresponding

  INTRODUCTION: Medication nonadherence is a key contributor to poor control of cardiovascular risk factors, but most interventions shown to increase adherence are labor-intensive and have not been implemented widely. Gamification interventions informed by behavioral economic theory increase physical activity with minimal cost and personnel requirements. We tested the feasibility of a gamification intervention to increase medication adherence among patients at risk of cardiovascular disease with a history of medication nonadherence. METHODS: Patients seen in a single primary care clinic who were prescribed 1 or 2 antihypertensive medications and a statin and had a recent history of nonadherence were identified and offered enrollment in a pilot randomized controlled trial. Patients were enrolled on the Penn Way to Health platform, provided with a validated home blood pressure cuff, and randomized to attention control or gamification. Attention control patients received daily text messages asking if they took their antihypertensive medication and statin, and biweekly text messages asking them to check and report their blood pressure. Gamification participants received the same text messages, and were also enrolled in a game in which they were provided with 90 points per week and lost 10 points each day they did not report taking their antihypertensive medications or statin and each time they did not report a blood pressure when requested. Each week, participants with 70 points or more moved up a level; those with less than 70 points moved down a level. The intervention continued for 14 weeks, followed by a 4-week post-intervention follow-up period. The trial's primary outcome was self-reported adherence. RESULTS: A total of 622 patients were eligible for the study and were contacted by study staff; ultimately 43 (of a planned 84) were enrolled and randomized to gamification (n = 21) or control (n = 22). Mean (SD) age was 65 (7.2), 20 (46.5%) were women, and 25 (58.1%) were Black. Over the 18-week study period, there was no significant difference between arms in adherence to antihypertensive medications (79.6% [gamification] vs. 78.6% [control]; difference between arms, 1.4%, 95% CI -1.2 to 3.9%) or statins (80.4% [gamification] vs. 78.6% [control]; difference between arms, 1.8%, 95% CI -2.2 to 5.9%). There were no differences in self-reported adherence between arms over the post-intervention follow-up period, and similarly no differences between arms in medication adherence by SureScripts data, systolic blood pressure, or low-density lipoprotein cholesterol. CONCLUSIONS: In this pilot randomized controlled trial, we found that a behaviorally-designed gamification intervention did not increase adherence to antihypertensive medications and statins compared with attention control. Challenges with recruiting patients with a history of poor adherence and lack of tools for automated, inexpensive, unobtrusive measurement of daily medication-taking behavior are key limitations to the deployment of gamification to increase medication adherence. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov; unique identifier: NCT05326386.

  PublisherDOI

• REPLY

  JACC CardioOncology · 2026-04-01

  articleOpen access1st authorCorresponding
  PublisherDOI

• Factor XI inhibition for ACS patients: premises and prospects

  EuroIntervention · 2025-07-01

  articleSenior author
  PublisherDOI

• Precision management of coronary in-stent restenosis

  Trends in Cardiovascular Medicine · 2025-07-23 · 6 citations

  review
  PublisherDOI

• Abstract 4351507: Older, non-White, Female and Uninsured Patients With a STEMI Are More Likely to be Transported to a non-Cardiac Cath Lab Center by EMS

  Circulation · 2025-11-03

  articleSenior author

  Background: For patients with ST segment elevation myocardial infarction (STEMI), rapid access to primary percutaneous coronary intervention (PPCI) is critical, and guidelines recommend communities create regional systems of care dedicated to reducing time to PPCI. Emergency medical services (EMS) transport of a patient with STEMI who lives near a hospital with a cardiac catheterization lab (CCL) to a hospital without a CCL represents a “system failure,” as it may delay PPCI. Research Questions: The study aimed to (1) assess the frequency and regional variability of EMS transport of patients with STEMI to a hospital without a CCL when a CCL was within a 60-minute drive (“system failure”); (2) compare demographic, socioeconomic, and clinical characteristics between patients with and without system failure; and (3) evaluate the association between system failure and time to PPCI. Methods: We analyzed data from the Get With The Guidelines- Coronary Artery Disease registry from January 1, 2020, to December 31, 2023. Adults with pre-hospital STEMI transported by ground EMS were included if they lived within 60 minutes of a CCL hospital. Patients were categorized as system failure (transport to non-CCL hospital) or no system failure (transport directly to CCL hospital). Baseline characteristics and in-hospital outcomes were compared between patients experiencing and not experiencing system failure, and generalized estimating equations adjusting for clinical, demographic, and hospital factors were used to evaluate associations between system failure status and treatment times. Results: Of 46,741 patients with STEMI meeting inclusion criteria, 16% were transported to a hospital without a CCL. System failure rates varied widely across hospital referral regions (HRRs) (Figure 1). On multivariable analysis, patients experiencing system failure were more likely to be older, female, non-White, and be Medicaid-insured or uninsured (p &lt; 0.01 for all comparisons). After adjustment, system failure was associated with significantly longer EMS First medical contact (FMC)-to-PCI times (+26 minutes; 95% CI, 10-42; p&lt;0.001) and lower odds of achieving FMC-to-PCI time ≤ 90 minutes (OR 0.63; 95% CI 0.51-0.78, p&lt;0.001). Conclusions: More than 1 in 6 STEMI patients living near CCL hospitals are transported to non-CCL hospitals, with resultant delays in timely reperfusion. Targeted efforts to optimize EMS transport protocols could improve timely access to reperfusion therapies.

  PublisherDOI

• Enrollment of Older Patients, Women, and Historically Underrepresented Racial and Ethnic Groups in Pulmonary Embolism Trials: A Systematic Review

  Journal of the Society for Cardiovascular Angiography & Interventions · 2025-10-30

  articleOpen accessSenior author
  PublisherOA PDFDOI

• PROGNOSTIC IMPLICATIONS OF PLATELET FCγRIIA DURING THE FIRST YEAR AFTER MYOCARDIAL INFARCTION

  Journal of the American College of Cardiology · 2025-03-29

  articleOpen access
  PublisherDOI

• Advancing In-Hospital Mortality Prediction for Acute Myocardial Infarction: an analysis from the American Heart Association Get-With-the-Guidelines Coronary Artery Disease Registry

  American Heart Journal · 2025-07-05

  preprintOpen access
  PublisherOA PDFDOI

Frequent coauthors

• Jay Giri

  University of Pennsylvania

  149 shared

• Ashwin S. Nathan

  133 shared

• David J. Cohen

  St. Francis Hospital

  100 shared

• Peter W. Groeneveld

  Philadelphia VA Medical Center

  100 shared

• Matthew W. Sherwood

  Inova Fairfax Hospital

  95 shared

• W. Schuyler Jones

  Universität Hamburg

  90 shared

• Sreekanth Vemulapalli

  Duke University

  88 shared

• Pratik Manandhar

  Nepal Medical College Teaching Hospital

  85 shared

Education

• B.A., English

  Duke University

  2007

• M.D., Medicine

  Duke University School of Medicine

  2011

• Other, Clinical Research

  Duke University School of Medicine

  2018