Does care in the Veterans Health Administration (VA) improve the use of guideline-directed medications after acute myocardial infarction in men >65 years old compared to fee-for-service Medicare?
Care in the Veterans Health Administration for acute myocardial infarction is associated with equal or higher rates of guideline-directed medical therapy prescription compared to fee-for-service Medicare.
BACKGROUND: There is concern that care provided in the Veterans Health Administration (VA) may be of poorer quality than non-VA health care. We compared use of medications after acute myocardial infarction in the VA with that in non-VA healthcare settings under fee-for-service (FFS) Medicare financing. METHODS AND RESULTS: We used clinical data from 2486 VA and 29 249 FFS men >65 years old discharged with a confirmed diagnosis of acute myocardial infarction from 81 VA hospitals and 1530 non-VA hospitals. We reported odds ratios (ORs) for use of thrombolytics, beta-blockers, ACE inhibitors, or aspirin among ideal candidates adjusted for age, sample design (hospital academic affiliation, availability of cardiac procedures, and volume), and within-hospital clustering. Ideal VA candidates were more likely to undergo thrombolytic therapy at arrival (OR VA relative to Medicare 1.40 1.05, 1.74) or to receive ACE inhibitors (OR 1.67 1.12, 2.45) or aspirin (OR 2.32 1.81, 3.01) at discharge and equally likely to receive beta-blockers (OR 1.09 1.03, 1.40) at discharge. CONCLUSIONS: Ideal candidates in VA were at least as likely as those in FFS to receive medical therapies of known benefit for acute myocardial infarction.
Petersen et al. (Tue,) studied this question.
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