Abstract 315: Use of Echocardiography and Nuclear Scintigraphy for Patients with Heart Failure in the Veterans Administration and Medicare Systems

Abstract

Background: The high use of cardiac imaging in the United States is increasingly scrutinized. We sought to determine differences in cardiac imaging between the Veterans Healthcare Administration (VA) and Medicare for veterans with heart failure (HF). Methods: We analyzed VA and Medicare data from 2002 to 2009 to identify 2,536,556 unique veterans age 65 and older with a known diagnosis of HF for at least one year (those with care in both systems are excluded). The fraction of patients with an echocardiogram (ECHO) or nuclear scintigraphy (NUC) test was determined. Logistic regression was used to adjust for patient characteristics. Results: More veterans received care in Medicare (82%) than in the VA (18%) The mean age was 79 years, 93% were male and comorbidities were common: diabetes mellitus (44%), ischemic heart disease (67%), and chronic kidney disease (25%). Imaging per year was higher in Medicare compared to the VA for ECHO (51% vs. 21%) and NUC (18% vs. 8%, both p<0.0001). Use plateaued or decreased for all procedures after 2006 except for VA ECHO (Figure). After adjustment for patient characteristics the use odds ratio in Medicare (compared to VA) was 3.61 for ECHO (95% CI 3.58-3.64) and 2.82 for NUC (2.79-2.86). Adjusted 1 year mortality was lower in the VA, OR 0.80 (0.81-0.79). Conclusion: There is much greater use of imaging procedures among veterans in Medicare than in the VA not explained by patient characteristics and not associated with improved survival.