Veterans with heart disease often receive better care through VA than they would elsewhere
Cardiovascular care delivered through the U.S. Department of Veterans Affairs (VA) is often superior to non-VA community-based care, according to new data published in JACC: Advances.[1] In most other instances, VA and non-VA care are comparable to one another.
Military veterans face an increased risk of cardiovascular disease (CVD), making it especially important to ensure they receive high-quality care. To learn more about the cardiovascular care they receive, researchers compared patients treated through the Veterans Healthcare Administration (VHA), a key component of the VA, with those treated through community-based healthcare facilities.
“The VHA provides a broad spectrum of cardiovascular care, including prevention, general cardiology, coronary, structural, and electrophysiology interventions, cardiac surgery, advanced heart failure treatment and cardiac transplantation,” wrote co-first authors D. Elizabeth Le, MD, and Bhaskar L. Arora, MD, cardiologists with VA Portland Health Care, and colleagues. “Over 172 medical centers containing 139 cardiology departments, 79 catheterization laboratories, 60 electrophysiology laboratories, and 35 cardiac surgery programs are located throughout the country.”
The group reviewed a variety of previously completed studies. Overall, they found that cardiovascular care delivered through the VHA was typically equal to or better than community-based care.
For example, VHA facilities were linked to better survival rates for patients with a history of heart failure or acute myocardial infarction (AMI). Survival was also better after elective percutaneous coronary intervention for military veterans receiving treatment through the VHA. In addition, wait times appeared to be better across the board for VHA facilities, suggesting veterans may be forced to wait longer before receiving treatment if they were to seek care outside of the VHA system.
When it came to transcatheter aortic valve replacement (TAVR) and coronary artery bypass grafting (CABG) procedures, meanwhile, outcomes were mostly similar at VHA and community-based care facilities.
“Like the general medical community, VHA is providing more structural heart interventions, including TAVR, through stringently developed programs with national outcome monitoring and feedback,” the authors wrote. “Perhaps because of these processes, veterans undergoing TAVR in the VHA have similar rates of major adverse events or conversion to open surgery when compared to historical controls from the community despite relatively low institutional volumes.”
One exception to the group’s findings did stand out: the readmission rate for patients after an AMI has not improved over time as much for VHA patients as it has for community-based care patients.
“AMI readmissions after VHA hospitalization require attention,” the authors wrote.
The group did highlight certain limitations to this work. Total costs could not be accurately compared, for example, and it is always possible certain facilities may not be associated with the favorable outcomes identified in this analysis.
“Much of the cardiovascular care delivered directly by the VHA that has been studied to date has been demonstrated to be equivalent or better than that delivered by non-VHA community due to well-established integration of high-quality medical care, extensive social support programs, and innovation,” the researchers concluded.
Click here to read the full analysis in JACC: Advances, an American College of Cardiology journal.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.