Why the study?
How have the risk profiles and operative mortality of VA patients undergoing CABG changed from 1997 to 2011?
How have the risk profiles and operative mortality of VA patients undergoing CABG changed from 1997 to 2011?
Operative mortality for CABG in the VA system has decreased over time despite patients presenting with increasingly complex risk profiles.
Declining VA CABG mortality despite rising complexity may reflect care advances; leaves open causal mechanisms and external validity.
From 1997 to 2011, there was a progressive increase in the prevalence of obesity, diabetes, left main coronary artery disease, and advanced NYHA heart failure class among VA patients undergoing CABG. The prevalence of previous myocardial infarction, low ejection fraction, and advanced angina decreased, perhaps because of earlier surgical referral, improvement in medical management, or a shift in patient selection for CABG. Operative mortality also decreased with time. These trends confirm the general perception of significant, ongoing improvement in the care of patients who undergo CABG in the VA, despite an older, sicker population.
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Cornwell et al. (2015) studied this question.
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