Comparison of use of medications after acute myocardial infarction in the Veterans Health Administration and Medicare.
BACKGROUND
There is concern that care provided in the Veterans Health Administration (VA) may be of poorer quality than non-VA health care. We compared use of medications after acute myocardial infarction in the VA with that in non-VA healthcare settings under fee-for-service (FFS) Medicare financing.


RESULTS
We used clinical data from 2486 VA and 29 249 FFS men >65 years old discharged with a confirmed diagnosis of acute myocardial infarction from 81 VA hospitals and 1530 non-VA hospitals. We reported odds ratios (ORs) for use of thrombolytics, beta-blockers, ACE inhibitors, or aspirin among ideal candidates adjusted for age, sample design (hospital academic affiliation, availability of cardiac procedures, and volume), and within-hospital clustering. Ideal VA candidates were more likely to undergo thrombolytic therapy at arrival (OR [VA relative to Medicare] 1.40 [1.05, 1.74]) or to receive ACE inhibitors (OR 1.67 [1.12, 2.45]) or aspirin (OR 2.32 [1.81, 3.01]) at discharge and equally likely to receive beta-blockers (OR 1.09 [1.03, 1.40]) at discharge.


CONCLUSIONS
Ideal candidates in VA were at least as likely as those in FFS to receive medical therapies of known benefit for acute myocardial infarction.
Petersen
L A
LA
Houston Center for Quality of Care and Utilization Studies, a Health Services Research and Development Center of Excellence, Houston VAMedical Center, Houston, TX 77030, USA. laurap@bcm.tmc.edu.
Normand
S L
SL
Leape
L L
LL
McNeil
B J
BJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D018588:Fee-for-Service Plans; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000188:drug therapy*; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy; D014728:Veterans / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin