Heart attack deaths declining for VA patients

NEW YORK (Reuters Health) - Deaths among people treated for heart attack at Veterans Affairs (VA) hospitals have fallen since 2003, mirroring worldwide trends, new research shows.

The researchers also found that, from 2000 to 2005, death rate at 30 days after a heart attack declined at the same rate for VA patients as it did for Medicare patients cared for at private hospitals.

The VA launched a major effort to improve the quality of heart care after a study found higher death rates for heart attack patients treated at VA hospitals compared to Medicare patients treated at non-VA hospitals, Dr. Stephan D. Fihn of the VA Puget Sound Health Care System and the University of Washington in Seattle and his colleagues note.

To follow up, Fihn and his team looked at 30-day death rates for 11,609 heart attack patients treated at VA hospitals between 2004 and 2006. They also compared records for 27,494 VA patients 65 and older and 789,400 Medicare patients who had heart attacks in 2000-2001 or 2004-2005.

Their analysis of the first data set found that death rates fell from 16.3 percent in 2004 to 13.9 percent in 2006, representing a 15 percent relative decline.

In the second data set, the researchers found, 30-day mortality after heart attack declined from 16 percent in 2000-2001 to 15.7 percent in 2004-2005 for the VA patients, and from 16.7 percent to 15.5 percent in private hospitals.

Once the researchers adjusted for health conditions, type of heart attack, and other factors, they found that the decline in mortality for the VA patients and for the Medicare patients treated in private hospitals was similar.

These findings, the researchers say, appear to "lay to rest" concerns that were raised recently that death among patients treated for heart attacks in VA hospitals appeared significantly higher than for patients whose care was funded by Medicare.

They point out that the original study, which covered the period from 1996 to 1999, didn't account for the fact that VA patients who suffered heart attacks were more likely to have been hospitalized for other causes.

The Veterans Health Administration's "aggressive" efforts to improve heart care may account for the decline in heart attack deaths, the researchers note; these hospitals also ensure that nearly all patients get heart-protecting drugs like statins, beta blockers and aspirin after a heart attack.

Fihn and his team note that VA patients typically adhere to their medication regimens more closely than Medicare patients do, likely because they are usually able to get their drugs at a much lower cost.

SOURCE: BMC Cardiovascular Disorders, August 31, 2009.