April 12, 2003
WASHINGTON -- Heart attack victims who sought care at Veterans Affairs hospitals had higher death rates than Medicare patients treated at community facilities, according to a VA study released Friday.
The study, involving about 4,000 heart attack victims a year during 1997-99, found that veterans treated at VA hospitals were less likely than Medicare patients to have invasive cardiac procedures, such as angioplasty, angiography or surgery.
Also, veterans who sought VA care when they experienced heart attack symptoms traveled an average of 30 miles for treatment, compared with Medicare patients who traveled an average 15 miles. However, the study did not conclude those were the reasons for the death rate differences.
"The findings ... are unacceptable and immediate action is required and will be taken," VA Secretary Anthony Principi said.
The study found that 50.2 percent of veterans who had heart attacks in 1997 died three years later, compared with 40.5 percent of Medicare patients. Also in 1997, veterans were 9.3 percent more likely to die two years after the heart attack, 6.3 percent more likely one year later.
In 1998, veterans had a 5.2 percent higher death rate two years after and in 1999, veterans had a 6.2 percent higher death rate one year after the heart attack. Statistics for three years after the heart attack were not available for 1998 and 1999.
Researchers in the study said they matched veterans with similar Medicare patients who were 65 years or older and from a national sample.
"It's kind of sad to think that Medicare patients are receiving better care than veterans," said Bill Bradshaw, Veterans of Foreign Wars veterans services director. "We think it's totally unacceptable."
One of the more glaring findings was that even when veterans were in facilities that had the technology and equipment to provide more invasive procedures such as angioplasty or catheterization, veterans were less likely to receive that kind of care.
Additionally, blacks and Hispanics were less likely to undergo the more invasive procedures and had shorter lengths of stay than white patients.
The results prompted Principi to order that nationally recognized guidelines for treatment of heart attacks and their symptoms be implemented at agency facilities and that they be used to evaluate the facilities' performance.
He ordered a review of cardiac care at all VA facilities, called for modernization of high-volume sites and ordered that 24-hour, 7-days a week care be available for heart attack victims at VA facilities. If it's not, veterans will be transferred to appropriate hospitals.
Principi is forming a commission of independent cardiologists, surgeons and emergency room physicians to evaluate VA's treatment of heart attack victims, procedures and staffing. Their initial recommendations are due in 90 days.
The study was conducted by PriceWaterhouseCoopers, Harvard Medical School Department of Health Policy, the Lewin Group and IBM Consulting Services.