Abstract
BackgroundMortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.MethodsWe calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, 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 VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR) files.ResultsUsing EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI 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 on 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).ConclusionMortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.
Highlights
Mortality from acute myocardial infarction (AMI) is declining worldwide
In the area of cardiac care, studies performed a decade ago found that mortality following acute myocardial infarction (AMI) among patients treated in Veterans Health Administration (VHA) facilities was similar to that of patients whose care was funded by Medicare in non-Veterans Affairs (VA) hospitals. [11,12] Subsequently, in an external study commissioned by VA that used administrative data from patients hospitalized with AMI between
Trends in Mortality in VHA Based upon VA External Peer Review Program (EPRP) data, there were a total of 11,609 patients with AMI available for analysis including 4411 in 2004, 4412 in 2005 and 2786 in 2006
Summary
Mortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has been declining. [3] On most of the ORYX measures publicly reported by The Joint Commission, VHA's most recent average national scores equaled or exceeded mean scores for non-VA facilities.[4] These achievements reflected by performance measures are paralleled by data indicating that adjusted mortality was lower over a fouryear period for patients receiving care in VHA compared with those enrolled in the Medicare Advantage program. In the area of cardiac care, studies performed a decade ago found that mortality following acute myocardial infarction (AMI) among patients treated in VHA facilities was similar to that of patients whose care was funded by Medicare in non-VA hospitals. A subsequent study, showed that the higher mortality within VHA reported by Landrum, et al was likely an artifact related to a much higher proportion of patients who suffered an AMI after being admitted to the hospital for another medical problem in the VA system than in the Medicare cohorts. Because mortality related to cardiac disease has been declining worldwide, we were interested in comparing trends within VHA with the Medicare population as an indication of secular trends. [16]
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