Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure

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Bottom Line: Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Why The Research Is Interesting: Ischemic heart disease (IHD) and chronic heart failure (CHF) are common in the VA health care system. The risk of death is high for both conditions. Little is known about the variation between VA medical centers in outcomes of care for patients with chronic, high-risk cardiovascular conditions such as these.

Who and When: 930,079 veterans with IHD and 348,015 veterans with CHF who received inpatient or outpatient care between 2010 and 2014 at 138 VA medical centers.

What (Study Measures): Mortality rates for IHD and for CHF across the 138 medical centers (exposures); death from any cause (outcome)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Peter W. Groeneveld, M.D., M.S., Veterans Affairs Medical Center, Philadelphia, and coauthors

Results: Mortality rates varied across VA medical centers from 5.5 percent to 9.4 percent for IHD and 11.1 percent to 18.9 percent for CHF.

Study Limitations: Administrative data do not measure disease severity and it is possible differences in mortality rates across VA medical centers were partially caused by differences in disease severity and other factors.

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Related material: The editorial, "In Pursuit of Better Measures of Quality of Care," by Paul Heidenreich, M.D., M.S., VA Palo Alto Health Care System, Palo Alto, California, is also available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamacardio.2018.1115)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Jonathan Hodges
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@JAMACardio

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