Health Services Research & Development

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Chronic Diseases

VA Implements System-Wide Tracking System for Cardiac Catheterization

Heart disease is the leading cause of death for both men and women in the United States and worldwide. It also is one of the most frequent indications for hospitalization within the VA healthcare system. A recent study shows that among Veterans hospitalized for cardiovascular disease between January 2010 and December 2014, the top five causes were coronary atherosclerosis, heart failure, acute myocardial infarction, stroke, and atrial fibrillation.1 To address reported disparities in the quality of cardiovascular care received by Veterans compared to non-Veterans, VA introduced a multi-layered plan to improve cardiovascular care by opening new catheterization labs, adopting national VA performance measures, and developing a national quality improvement program for cardiac catheterization procedures.2 Working with VA Patient Care Services, the Office of Quality and Performance, and the Office of Information and Technology, “The Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories” (CART-CL) was developed by VA HSR&D’s Quality Enhancement Research Initiative (QUERI).

Integrated within VA’s computerized patient record system (CPRS), key features of CART-CL include:

  • Standardized data capture and reporting across all VA cath labs;
  • Single national data repository for tracking and documenting cardiac procedures performed in VA cath labs;
  • Centralized platform to support quality improvement – both local and national quality improvement programs; and
  • Extensible database structure to support modification based on input from test sites, updating to evolving standards, and expansion of the clinical scope of the project.

CART-CL improves patient safety

In 2003, CART-CL was piloted in a handful of VA cardiac catheterization laboratories, and was subsequently adopted by the Under Secretary for Health and the National Leadership Board for implementation nationwide. In addition, in FY08, VA finalized a Memorandum of Understanding with the U.S. Food and Drug Administration (FDA) to enable the use of CART-CL for the surveillance of potential safety problems related to cardiac devices. This collaboration established CART-CL as a sentinel patient safety network and contributed significantly to active post-market surveillance. Most importantly, it may improve patient safety through enhanced communications and provider understanding of reportable events.

CART-CL has been successfully implemented in all VA cath labs, and is regarded as a model for clinical application development and implementation within the VA healthcare system. 

  1. Krishnamurthi N, Francis J, Fihn S, et al. Leading causes of cardiovascular hospitalization in 8.45 million US Veterans. PLoS One. July 2018;13(7).
  2. Box T, McDonell M, Helfrich C, et al. Strategies from a nationwide health information technology implementation: The VA CART story. Journal of General Internal Medicine. January 2010;25(Suppl 1):72-76.