VA health systems vary widely in heart disease death rates

By Lisa Rapaport

(Reuters Health) - Heart disease death rates vary substantially at Veterans Affairs hospitals nationwide, and a new study suggests that this holds true not just for hospitalized patients but also for outpatients.

Previous research has long documented differences in death rates at hospitals across the U.S., not just at VA facilities, often focusing on deaths among hospitalized patients or within a month after discharge. The current study, however, offers fresh insight by looking at combined mortality rates for inpatient and outpatient care.

Researchers studied 930,079 veterans with heart disease and 348,015 with congestive heart failure who received care at 138 VA health systems nationwide from 2010 to 2014.

At the various locations, annual death rates for heart disease ranged from a low of 5.5 percent to a high of 9.4 percent, while mortality rates for congestive heart failure ranged from 11.1 percent to 18.9 percent, researchers calculated.

"The quality of care for chronic heart disease may differ across hospitals, thus some hospitals may be better at providing continuity care to patients with chronic heart disease," said lead study author Dr. Peter Groeneveld of the Corporal Michael J. Crescenz VA Medical Center in Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.

"There are also numerous evidence-based therapies that have been shown to reduce heart failure mortality, but the use of these therapies varies widely," Groeneveld said by email.

The study wasn't designed to prove how care provided at specific hospitals and clinics might directly contribute to mortality rates.

However, the variation in mortality rates at VA hospitals likely mirrors what's would be seen at other hospitals and health systems, Groeneveld added. And some differences in patient populations that weren't possible to measure in the study, such as disease severity, frailty, dementia or socioeconomic status, might have influenced death rates, he said.

More than four in five patients in the study had hypertension and about half of them had diabetes, researchers note in JAMA Cardiology May 16.

These patients with multiple chronic health problems have a high risk of serious complications and death. It's not clear from the study results how much hospitals and clinics can control mortality rates, said, Dr. Paul Heidenreich of the VA Palo Alto Health Care System and Stanford University School of Medicine in California.

"Some of the difference in mortality may be due to differences in patients for which we can't control (because we don't have data systems to track them) and some may be due to differences in quality of care," Heidenreich, author of an accompanying editorial, said by email.

"The study adds to this knowledge by showing that this variation in mortality is present for outpatients as well and extends well beyond 30 days (after patients leave the hospital)," Heidenreich added. "If the variation is due to differences in care, then knowing these differences will matter to patients and be important for the health care system to address."

SOURCE: https://bit.ly/2IRekG8 and https://bit.ly/2xms6j9

JAMA Cardiol 2018.