Elective PCI for veterans at community centers confers higher mortality vs. VA centers
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Despite the greater risk for mortality, elective PCI for veterans with stable angina performed at community care centers rather than integrated Veterans Affairs health care centers increased from 2015 to 2018, researchers reported.
“Previous research has shown that this system provides high-quality health care but has been limited by concerns regarding patient access,” Stephen W. Waldo, MD, cardiologist at the Rocky Mountain Regional VA Medical Center in Aurora, Colorado, and colleagues wrote. “Because of this, the organization has expanded access to clinical care outside of the integrated health care system with the development of a community care program that enables veterans to receive care from nonfederal facilities, with the expenses covered by the federal government. These services are primarily offered if the VA integrated health care system cannot provide access to specialist care in a timely manner.”
For this study, published in the Journal of the American College of Cardiology, investigators evaluated the likelihood of patients to undergo elective PCI for stable angina at either a VA or community care center, as well as all-cause mortality at 1 year. Researchers included 8,913 patients actively enrolled in the VA Healthcare System who underwent PCI from October 2015 to 2018. Overall, 67% of participants underwent PCI at a VA health care center while the remainder received treatment at a community center.
In 2015, 38.9% of elective PCIs for stable angina were done in community centers. That number increased to 51.8% by 2018.
Although elective PCI at community center became more common by the end of the study period, investigators observed a 33% increase (HR = 1.33; 95% CI, 1.09-1.62) in risk for mortality among these patients compared with those treated at a VA health care center (absolute difference, 1.4%; 95% CI, 0.2-2.6).
After completing a censored analysis, researchers found that during the first month after elective PCI at a community center, there was a 143% increase in risk for death (HR = 2.43; 95% CI, 1.5-3.94) compared with PCI performed at a VA center (absolute difference, 0.7%; 95% CI, 0.3-1.2).
“The continued divergence over time also suggests potential deficiencies in the coordination of postprocedural care and possible differences in the medical management of coronary artery disease,” the researchers wrote. “Although residual confounding could be present, it would take a factor with a sizeable difference in prevalence between treatment groups (approximately 7%) associated with a significant increase in risk (approximately 164%) to completely nullify these findings.”
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