Veterans experience worse PCI outcomes at community hospitals than VA facilities

The U.S. Department of Veterans Affairs (VA) launched the MISSION Act in 2019 to provide veterans with more community-based options when they seek healthcare. According to a new study published in the Journal of the American College of Cardiology, however, the chance of mortality is much higher for veterans undergoing percutaneous coronary intervention (PCI) procedures at community hospitals than those being treated at VA hospitals.

Researchers tracked elective PCI outcomes for nearly 9,000 patients enrolled in the VA Healthcare System from Oct. 1, 2015, to Dec. 31, 2018. Sixty-seven percent of those patients were treated within the VA Healthcare System, and the other 33% were treated at community facilities.

Overall, the team observed a 33% increase in a patient’s hazard for mortality if they received care at a community hospital. The hazard of death jumped a whopping 143% in the first month following the procedure.  

Does improving veterans’ access to healthcare really make a big difference if their outcomes suffer as a result? What can be done to reverse this trend?

“The Clinical Assessment, Reporting, and Tracking (CART) Program monitors the quality and safety of invasive cardiac procedures for those treated within the VA Healthcare System, where clinical outcomes have remained constant or improved despite treatment of a more comorbid population,” wrote lead author Stephen W. Waldo, MD, national director of the CART Program, and colleagues. “A similar organization to monitor the same quality of care for veterans treated in the community does not currently exist on a national scale. Because the VA Healthcare System serves as an unrecognized national safety net, we must ensure that increased access to medical care is accompanied by mechanisms to ensure similar levels of quality regardless of treatment venue.”

The full analysis from the Journal of the American College of Cardiology can be read here.