title: Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System.
abstract: 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.
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA, USA. Stephan.Fihn@va.gov
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
authors.forename: Elliott
authors.initials: E
authors.lastname: Lowy
authors.forename: Ioana
authors.initials: I
authors.lastname: Popescu
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
authors.forename: John
authors.initials: J
authors.lastname: Rumsfeld
authors.forename: Sandy
authors.initials: S
authors.lastname: Piñeros
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Christian D
authors.initials: CD
authors.lastname: Helfrich
authors.forename: Roxane
authors.initials: R
authors.lastname: Rusch
authors.forename: Robert
authors.initials: R
authors.lastname: Jesse
authors.forename: Peter
authors.initials: P
authors.lastname: Almenoff
authors.forename: Barbara
authors.initials: B
authors.lastname: Fleming
authors.forename: Michael
authors.initials: M
authors.lastname: Kussman
mesh_terms: 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*