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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
06:02

Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens

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Variations in the use of cardiac procedures in the Veterans Health Administration

D M Mirvis1, M J Graney

  • 1Department of Veterans Affairs Medical Center, Memphis, TN, USA. dmirvis@utmem1.utmem.edu

American Heart Journal
|March 31, 1999
PubMed

Insights

Local hospital features significantly impact cardiac procedure rates in the Veterans Affairs system. Geographic location and hospital complexity influence access to catheterization, angioplasty, and bypass grafting, despite referral networks.

Area of Science:

  • Cardiovascular medicine
  • Health services research
  • Health economics

Background:

  • Variability in cardiac procedure use is linked to local facility availability.
  • Structured referral systems aim to mitigate resource disparities in the Veterans Affairs (VA) health care system.

Purpose of the Study:

  • To identify health system features associated with rates of cardiac catheterization, percutaneous coronary angioplasty, and coronary artery bypass graft surgery within the VA.
  • To assess the impact of local facility availability on procedure utilization.

Main Methods:

  • Analysis of medical records for 30,901 patients with coronary artery disease at VA medical centers.
  • Logistic regression used to estimate odds ratios (OR) and confidence intervals (CI) for undergoing procedures.
  • Inclusion of clinical variables and local VA facility features (geographic region, service area size, hospital complexity).

Main Results:

  • Geographic region and hospital complexity were significantly associated with undergoing cardiac procedures, even after adjusting for clinical factors.
  • Presence of a cardiac catheterization laboratory increased odds of catheterization (OR 1.86).
  • Presence of a cardiac surgical program increased odds for angioplasty (OR 1.46) and bypass grafting (OR 1.43).
  • Health system variables improved model discrimination by 44.2%–51.4%.

Conclusions:

  • Local hospital characteristics, specifically geographic location and complexity, are key determinants of cardiac procedure use in the VA.
  • These factors influence procedure rates despite the intended corrective function of referral networks.
  • Understanding these determinants can inform strategies to reduce disparities in cardiovascular care access.
Abstract

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