September 18, 2009

Heart Attack Mortality Seen Declining Among VHA Patients

In response to research findings several years ago suggesting excess mortality following acute myocardial infarction (AMI), VA implemented an ambitious initiative intended to improve acute cardiac care. This study sought to evaluate trends in mortality within VHA after this initiative was undertaken, and to compare them with mortality rates among patients admitted to hospitals funded by Medicare. The investigators compared 30-day mortality rates among patients age 65 and older treated for AMI in VHA (n=27,494) with rates for Medicare patients treated in private sector hospitals (n= 789,400) between 2000 and 2006. They found that mortality in VHA following AMI declined over the study period, and that this decline was commensurate with rates observed in the Medicare population. From January 2000 through June 2005, overall unadjusted 30-day mortality was 16.0% in VA hospitals compared with 16.2% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall mortality rates were similar for VA and Medicare. Moreover, using detailed clinical data from VA's External Peer Review Program (EPRP) on 11,609 VA patients, investigators observed a significant decline in adjusted 30-day mortality following AMI - from 16.3% in 2004 to 13.9% in 2006, which is a decrease in the odds of dying of 10% each year. [EPRP data was available for calendar years '04-'06 only.]

The authors hypothesize that the decrease in AMI-related mortality within VA may, in part, have been related to an aggressive effort undertaken within the VA healthcare system over the past four years that included an expansion of performance measurement and quality improvement systems. They also suggest that a major effect was the widespread use of cardioprotective medications and high levels of adherence among Veteran patients.

Fihn S, Vaughan-Sarrazin M, Lowy E, et al. Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System. BMC Cardiovascular Disorders August 31, 2009;9(1):44. [E-pub ahead of print]

This study was funded by HSR&D. Dr. Fihn is Director of VA/HSR&D's Ischemic Heart Disease Quality Enhancement Research Initiative (IHD-QUERI); he's also Director of HSR&D's Northwest Center for Outcomes Research in Older Adults.