Comparison of 30-Day Mortality After Diagnostic Coronary Angiography at VA and Community Hospitals
Denise M Hynes1,2,3, Diana J Govier4,5, Alex Hickok4
1Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA. denise.hynes@va.gov.
Insights
Veterans undergoing diagnostic coronary angiography (DCA) in community care (VACC) had higher 30-day mortality compared to VA facilities (VAF). Further research is needed to improve VACC follow-up and outcomes.
Area of Science:
- Cardiology
- Health Services Research
- Outcomes Research
Background:
- The US Department of Veterans Affairs (VA) provides care through its own facilities (VAF) and community care (VACC).
- The comparative outcomes of diagnostic coronary angiography (DCA) between VAF and VACC are not well understood.
- This study addresses the knowledge gap regarding DCA outcomes in VAF versus VACC.
Purpose of the Study:
- To compare 30-day all-cause and cardiac-related mortality for DCA performed in VAF versus VACC.
- To evaluate the safety and effectiveness of DCA delivery models within the VA system.
Main Methods:
- Retrospective cohort study utilizing pooled cross-sectional analysis of 31,640 VA patients undergoing outpatient DCA from October 2015 to June 2019.
- Patients were matched on nine baseline characteristics to ensure comparability between VAF and VACC groups.
- Weighted regression adjustment was used to estimate average treatment outcomes for VACC, with sub-analyses stratified by valvular disease and heart failure diagnoses.
Main Results:
- A higher proportion of DCAs (28.06%) were performed through VACC.
- Patients undergoing DCA in VACC experienced significantly greater odds of 30-day all-cause (aOR 6.918), cardiac-related (aOR 6.112), and non-cardiac related (aOR 13.45) mortality compared to those in VAF.
- These increased mortality risks associated with VACC DCA were consistent across all subgroups analyzed.
Conclusions:
- Diagnostic coronary angiography in VACC settings is associated with increased 30-day mortality among VA patients.
- There is a critical need to investigate strategies for enhancing patient follow-up and improving outcomes in VACC settings for DCA.
- Optimizing care pathways for DCA within community care is essential for ensuring comparable patient safety and outcomes.
Background:
The US Department of Veterans Affairs (VA) delivers care in its own facilities (VAF) and purchases community care (VACC) for some services including diagnostic coronary angiography (DCA). Whether patients experience comparable outcomes for DCA through VAF and VACC is unknown.
Objective:
To compare 30-day all-cause and cardiac-related mortality associated with DCA in VAF and VACC.
Design:
Retrospective cohort study with pooled cross-sectional analysis.
Participants:
VA patients who lived in the USA and underwent outpatient DCA in VAF or VACC between October 2015 and June 2019 (N = 31,640) were matched on nine baseline characteristics: age, race, rurality, drive distance to nearest VA primary care site, history of ischemic heart disease, history of valvular disease, procedure fiscal year, insurance status, and Elixhauser comorbidity index. Analysis was conducted from 2023 to 2025.
Main Measures:
Thirty-day all-cause and cardiac-related mortality. Average treatment outcomes of VACC were estimated using weighted regression adjustment to account for selection into VACC. Sub-analyses included regression models stratified by diagnosis of valvular disease and heart failure.
Key Results:
Among 31,640 DCAs, 28.06% were performed through VACC. VACC and VAF DCAs were well-balanced. Overall, 30-day all-cause mortality was 0.96% (2.49% in VACC and 0.37% in VAF [SMD = 0.182]), and most were cardiac-related. Compared with those who underwent DCA at VAF, those who had DCA at VACC had greater odds of 30-day all-cause (aOR 6.918, 95% CI = 4.521, 10.586), cardiac-related (aOR 6.112, 95% CI 3.715, 10.055), and non-cardiac related (aOR 13.45, 95% CI 5.352, 33.801) mortality. In stratified models, VACC DCA was associated with greater odds of 30-day mortality for all subgroups.
Conclusions:
Results highlight the need for further research regarding strategies to improve follow-up and outcomes for VA patients undergoing DCA, particularly in VACC settings.
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