Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3038 — Continuity of Cardiology Care and Mortality for Patients with Acute Coronary Syndrome in the VHA

Ho PM (REAP-Denver) , Gupta I (IHD-QUERI), Lowy E (IHD-QUERI), Maynard C (IHD-QUERI), Sales AE (IHD-QUERI), Masoudi FA (Denver Health Medical Center), Luther S (University of Colorado Health Sciences Center), Peterson ED (Duke Clinical Research Institute), Fihn SD (IHD-QUERI), Rumsfeld JS (REAP-Denver)

Objectives:
Inpatient cardiology care is associated with lower mortality for AMI. The impact of continuity of cardiology care for patients after ACS hospital discharge is unknown.

Methods:
This was a retrospective cohort study of all ACS patients admitted to Veterans Health Administration facilities from 2003-2004. Patients were stratified into 4 categories of cardiology care based on the presence or absence of inpatient cardiology involvement and outpatient cardiology clinic visit within 60 days of hospital discharge. Multivariable regression analysis assessed the association between different levels of cardiology care and all-cause mortality, adjusting for demographics, co-morbidities, hospital presentation and treatment variables, and accounting for clustering by site. The median follow-up was 697 days.

Results:
Of 5,768 ACS patients, the majority had inpatient (94.5%) and outpatient cardiology involvement (73.5%). Patients with both inpatient and outpatient cardiology involvement were more likely to have prior cardiac disease (e.g., prior MI, coronary revascularization, and heart failure) and to present with a myocardial infarction compared to patients without any cardiology involvement. All-cause mortality was lowest for patients with both inpatient and outpatient cardiology involvement (20.3% vs. outpatient only, 23.7% vs. inpatient only, 25.1% vs. no cardiology involvement, 26.3%; p=0.001). In multivariable analysis, patients with both inpatient and outpatient cardiology involvement had significantly lower mortality risk (HR 0.67; 95% CI 0.47-0.94) compared with patients without any cardiology involvement. In contrast, there was no significant survival difference between patients with only inpatient cardiology (HR 0.89; 95% CI 0.62-1.21) or only outpatient cardiology (HR 0.84; 95% CI 0.55-1.27) involvement versus no cardiology involvement.

Implications:
Patients with continuity of cardiology care following ACS hospitalization had the lowest mortality risk.

Impacts:
Future studies should identify mediators of this potential benefit and determine if interventions enhancing the continuity of subspecialty care following ACS will improve patient outcomes.