Author + information
- Received January 26, 2018
- Revision received February 16, 2018
- Accepted February 27, 2018
- Published online May 2, 2018.
- Stephen W. Waldo, MDa,∗ (, )
- Madhura Gokhale, MSa,
- Colin I. O’Donnell, PhDa,
- Mary E. Plomondon, PhDa,
- Javier A. Valle, MD, MSCSa,
- Ehrin J. Armstrong, MD, MSca,
- Richard Schofield, MDb,
- Stephan D. Fihn, MD, MPHc and
- Thomas M. Maddox, MD, MScd
- aDepartment of Medicine, Division of Cardiology, VA Eastern Colorado Healthcare System, Denver, Colorado
- bDepartment of Medicine, Division of Cardiology, VA National Program, Gainesville, Florida
- cDepartment of Medicine, VA Puget Sound Healthcare System, Seattle, Washington
- dDepartment of Medicine, Division of Cardiology, Washington University, St. Louis, Missouri
- ↵∗Address for correspondence:
Dr. Stephen W. Waldo, VA Eastern Colorado Healthcare System, Department of Medicine, Division of Cardiology, 1055 Clermont Street, Denver, Colorado 80238.
Objectives The aim of this study was to evaluate temporal trends in characteristics and outcomes among patients referred for invasive coronary procedures within a national health care system for veterans.
Background Coronary angiography and percutaneous coronary intervention remain instrumental diagnostic and therapeutic interventions for coronary artery disease.
Methods All coronary angiographic studies and interventions performed in U.S. Department of Veterans Affairs cardiac catheterization laboratories for fiscal years 2009 through 2015 were identified. The demographic characteristics and management of these patients were stratified by time. Clinical outcomes including readmission (30-day) and mortality were assessed across years.
Results From 2009 to 2015, 194,476 coronary angiographic examinations and 85,024 interventions were performed at Veterans Affairs facilities. The median numbers of angiographic studies (p = 0.81) and interventions (p = 0.22) remained constant over time. Patients undergoing these procedures were progressively older, with more comorbidities, as the proportion classified as having high Framingham risk significantly increased among those undergoing angiography (from 20% to 25%; p < 0.001) and intervention (from 24% to 32%; p < 0.001). Similarly, the median National Cardiovascular Data Registry CathPCI risk score increased for diagnostic (from 14 to 15; p = 0.005) and interventional (from 14 to 18; p = 0.002) procedures. Post-procedural medical management was unchanged over time, although there was increasing adoption of transradial access for diagnostic (from 6% to 36%; p < 0.001) and interventional (from 5% to 32%; p < 0.001) procedures. Complications and clinical outcomes also remained constant, with a trend toward a reduction in the adjusted hazard ratio for percutaneous coronary intervention mortality (hazard ratio: 0.983; 95% confidence interval: 0.967 to 1.000).
Conclusions Veterans undergoing invasive coronary procedures have had increasing medical complexity over time, without attendant increases in mortality among those receiving interventions. As the Department of Veterans Affairs moves toward a mix of integrated and community-based care, it will be important to account for these demographic shifts so that quality can be maintained.
Support for Veterans Affairs and Centers for Medicare & Medicaid Services data is provided by the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Dr. Waldo has received research support to the Denver Research Institute from Abiomed, Cardiovascular Systems, and Merck Pharmaceuticals. Dr. Armstrong has served as a consultant to Abbott Vascular, Boston Scientific, Cardiovascular Systems, Medtronic, and Spectranetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government.
- Received January 26, 2018.
- Revision received February 16, 2018.
- Accepted February 27, 2018.
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