Veterans undergoing elective PCI at community hospitals may have increased chance of death compared to those treated at VA hospitals

August 24, 2020

Veterans who underwent elective percutaneous coronary intervention (PCI) for stable angina at a community facility were at a 33% increased hazard, or chance, of death compared to patients treated within the Veterans Affairs (VA) Healthcare System, according to an analysis of nearly 9,000 veterans published today in the Journal of the American College of Cardiology.

Due to patient access concerns, the VA Healthcare System has expanded clinical care outside of the integrated system through a community care program that enables veterans to receive care from non-federal facilities. Facilities in the community care program range from academic medical centers to rural safety net hospitals, and since the community care program does not restrict access based on procedural volumes or quality, patients may choose facilities with differing levels of expertise.

According to the analysis, the utilization of community facilities for elective PCI has increased over 50% in the last three years. Overall, treatment in the community was associated with worse outcomes, including a 33% increased hazard of death within the first year after intervention and a 143% increased hazard of death within the first month.

"A larger proportion of Veterans are undergoing elective coronary intervention for stable angina in community facilities, a trend that will likely continue with the recent adoption of the MISSION ACT. The community facilities that provide care to these patients are heterogeneous, and the data available for quality assessment is largely limited to billing records," said Stephen W. Waldo, MD, National Director of the VA Clinical Assessment, Reporting and Tracking (CART) Program and lead author of the study. "While these data may be limited, this analysis suggests that clinical outcomes for Veterans undergoing percutaneous coronary intervention in the community may diverge from those treated within the VA Healthcare System. Because of this, we must ensure that increased access to medical care in the community is accompanied by mechanisms to ensure similar levels of quality."

Limitations include data for the VA Healthcare System was derived from clinical documentation whereas administrative billing data was used for care provided in community facilities. The limited data available on patients treated in community facilities means it is possible that more complex procedures were performed in that setting.

The researchers concluded that further study is needed to determine the most effective means to improves veterans' access to medical care while also maintaining quality.
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals--JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology, JACC: Basic to Translational Science, JACC: Case Reports and JACC: CardioOncology--that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at

American College of Cardiology

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