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Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System.

Fihn SD, Vaughan-Sarrazin M, Lowy E, Popescu I, Maynard C, Rosenthal GE, Sales AE, Rumsfeld J, Piñeros S, McDonell MB, Helfrich CD, Rusch R, Jesse R, Almenoff P, Fleming B, Kussman M - BMC Cardiovasc Disord (2009)

Bottom Line: 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).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).Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

View Article: PubMed Central - HTML - PubMed

Affiliation: VA Puget Sound Health Care System, Seattle, WA, USA. Stephan.Fihn@va.gov

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).

Conclusion: Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

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Adjusted mortality with 95% confidence intervals following AMI in VHA 2004 through 2006 (N = 11,609).
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Figure 1: Adjusted mortality with 95% confidence intervals following AMI in VHA 2004 through 2006 (N = 11,609).

Mentions: Using detailed clinical data to adjust for demographic and clinical factors, we observed a statistically significant decline in 30-day mortality following AMI 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, Table 3 and Figure 1). Similar declines were found for in-hospital and 90-day mortality.


Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System.

Fihn SD, Vaughan-Sarrazin M, Lowy E, Popescu I, Maynard C, Rosenthal GE, Sales AE, Rumsfeld J, Piñeros S, McDonell MB, Helfrich CD, Rusch R, Jesse R, Almenoff P, Fleming B, Kussman M - BMC Cardiovasc Disord (2009)

Adjusted mortality with 95% confidence intervals following AMI in VHA 2004 through 2006 (N = 11,609).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2746180&req=5

Figure 1: Adjusted mortality with 95% confidence intervals following AMI in VHA 2004 through 2006 (N = 11,609).
Mentions: Using detailed clinical data to adjust for demographic and clinical factors, we observed a statistically significant decline in 30-day mortality following AMI 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, Table 3 and Figure 1). Similar declines were found for in-hospital and 90-day mortality.

Bottom Line: 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).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).Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

View Article: PubMed Central - HTML - PubMed

Affiliation: VA Puget Sound Health Care System, Seattle, WA, USA. Stephan.Fihn@va.gov

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).

Conclusion: Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

Show MeSH
Related in: MedlinePlus