Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System.
BACKGROUND
Mortality from acute myocardial infarction (AMI) is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA) has also been declining.


METHODS
We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP), which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR) files.


RESULTS
Using EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011). Similar declines were found for in-hospital and 90-day mortality.Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08).


CONCLUSIONS
Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.
Fihn
Stephan D
SD
VA Puget Sound Health Care System, Seattle, WA, USA. Stephan.Fihn@va.gov
Vaughan-Sarrazin
Mary
M
Lowy
Elliott
E
Popescu
Ioana
I
Maynard
Charles
C
Rosenthal
Gary E
GE
Sales
Anne E
AE
Rumsfeld
John
J
Piñeros
Sandy
S
McDonell
Mary B
MB
Helfrich
Christian D
CD
Rusch
Roxane
R
Jesse
Robert
R
Almenoff
Peter
P
Fleming
Barbara
B
Kussman
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000401:mortality*; D016017:Odds Ratio; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*