Veterans who underwent elective PCI for stable angina at a community facility were at a 33% increased hazard, or chance, of death compared to patients treated within the Veterans Affairs (VA) Healthcare System, according to an analysis published Aug. 24 in the Journal of the American College of Cardiology.

Stephen W. Waldo, MD, FACC, et al., analyzed 8,913 patients who underwent percutaneous intervention for stable angina and received the dominant form of care in a given location. Out of the patients observed, 5,942 (67%) received PCI in the VA Healthcare System and 2,971 (33%) in the community facilities.

According to the study, utilization of community facilities for elective PCI has increased over 50% in the last three years. Results showed that overall, treatment in the community was associated with worse outcomes, including a 33% increased hazard of death within the first year after intervention and a 143% increased hazard of death within the first month.

"The community facilities that provide care to these patients are heterogeneous, and the data available for quality assessment is largely limited to billing records," Waldo said. "While these data may be limited, this analysis suggests that clinical outcomes for Veterans undergoing PCI in the community may diverge from those treated within the VA Healthcare System.

The authors conclude that further study is needed to determine the most effective means to improves veterans' access to medical care while also maintaining quality.

ACC.org Editor-in-Chief Kim A. Eagle, MD, MACC, comments, "While the findings are provocative, it is important to note that complete risk adjustment for care provided to patients across multiple sites and health systems is a challenge. Therefore, the findings should be viewed as hypothesis generating, not definitive."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Angina, Stable, Veterans, Hospitals, Community, Percutaneous Coronary Intervention, Hospitals, Veterans, Elective Surgical Procedures

< Back to Listings