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Vaughn-Sarrazin M (Iowa City VA Medical Center), Lowy E
(VA Puget Sound Health Care System), Popescu I
(Iowa City VAMC), Maynard C
(VA Puget Sound HCS), Rosenthal G
(Iowa City VAMC), Sales A
(University of Alberta), Jesse J
(Department of Veterans Affairs), Almenoff P
(Department of Veterans Affairs), Fleming B
(Department of Veterans Affairs), Kussman M
(Department of Veterans Affairs)
Objectives:
Mortality from acute myocardial infarction (AMI) is declining worldwide. An earlier study found mortality from AMI was higher for patients admitted to VHA than Medicare hospitals. We sought to assess recent trends in mortality following AMI in VA and comparisons with Medicare.
Methods:
To assess mortality within VHA, we calculated the adjusted 30-day mortality rates between 2004 and 2006 using data from the External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI (ICD-9-CM codes 410.xx) admitted to VA hospitals. We calculated 30-day adjusted mortality using a model developed and validated expressly for VA patients with and without cluster correction for hospital. Mortality was ascertained using the VA vital status file.
To compare trends in VA with Medicare, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VA Patient Treatment File and Medicare Provider Analysis and Review (MedPAR) files. We adjusted for sociodemographic characteristics, distance from admitting hospital, coexisting chronic conditions, and location of AMI.
Results:
Based on EPRP data on 11,609 patients, adjusted 30-day mortality following AMI declined in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p=.011). Similar declines were found for in-hospital and 90-day mortality. Based on administrative data from 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08).
Implications:
Mortality following AMI within VHA and Medicare-funded hospitals is comparable and has declined in both systems at a similar rate since 2003.
Impacts:
Contrary to earlier reports, outcomes of AMI in VA are similar to the private sector and have been improving significantly. This is likely due to a combination of more effective acute care and aggressive treatment of cardiac risk factors.
