TREATMENT OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION AT A VETERANS AFFAIRS (VA) HOSPITAL AND A NON-VA HOSPITAL

Comparisons of care in Veterans Affairs (VA) hospitals with care in no n-VA hospitals are needed to define the future role of the VA health c are system. Therefore, the authors conducted a retrospective cohort st udy of 385 patients who had acute myocardial infarctions and were admi tted to a private nonprofit teaching hospital and to a university-affi liated VA hospital, which were staffed by attending and resident physi cians from a single medicine department. Data were obtained from hospi tal databases and from patient records. The authors found that the 206 VA patients, compared with the 179 non-VA patients, were younger and more likely to be men. The VA patients also had higher comorbidity but lower admission severity of illness, according to previously validate d measures. Although the VA patients were less likely than the non-VA patients to receive thrombolytic therapy (6% vs 20%, respectively; p < 0.05), they were more likely to undergo coronary angiography (67% vs 57%; p < 0.05) and echocardiography or gated blood pool scanning (54% vs 44%; p < 0.05) during hospitalization. Finally, the VA and the non- VA patients had similar rates of in-hospital mortality in univariate a nalysis (9% vs 11%, respectively; p = 0.4) and in multivariate analysi s, adjusting for covariates. These results suggest that the VA and the non-VA patients who had acute myocardial infarction had similar outco mes and generally received care of similar qualities. Future studies a re needed to explore the generalizability of these findings and to pro vide the data needed to adequately define the VA's future role in Amer ican health care.