Ischemic Heart Disease, CHF Mortality Vary Across VA Systems
Risk-standardized mortality rates vary considerably across Veterans Affairs Medical Centers
HealthDay News — Risk-standardized mortality rates for ischemic heart disease (IHD) and chronic heart failure vary across Veterans Affairs Medical Centers (VAMCs), according to a study published online May 16 in JAMA Cardiology.
Peter W. Groeneveld, M.D., from the Veterans Affairs Medical Center in Philadelphia, and colleagues conducted a retrospective cohort study involving 138 VA hospitals and each hospital's affiliated outpatient clinics to examine the differences in cardiovascular outcomes. Separate cohorts were constructed for patients diagnosed with IHD (930,079 veterans) or chronic heart failure (348,015 veterans).
The researchers found that the crude annual mortality rate across VA was 7.4 and 14.5% for IHD and chronic heart failure, respectively. VAMC's risk-standardized mortality varied from 5.5 to 9.4% for IHD, and from 11.1 to 18.9% for chronic heart failure. Twenty-nine and 35 VAMCs had IHD and chronic heart failure mortality rates that significantly exceeded the national means, respectively. There was no association for VAMC mortality rates among IHD and chronic heart failure populations with 30-day mortality rates for myocardial infarction; a weak association was seen for hospitalized heart failure 30-day mortality and for the VA star rating system.
"Risk-standardized mortality rates for IHD and CHF varied widely across the VA health system, and this variation was not well explained by differences in demographics or comorbidities," the authors write. "This variation may signal substantial differences in the quality of cardiovascular care between VAMCs."