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Background <p>The US Department of Veterans Affairs (VA) delivers care in its own facilities (VAF) and purchases community care (VACC) for some services including diagnostic coronary angiography (DCA). Whether patients experience comparable outcomes for DCA through VAF and VACC is unknown.</p> Objective <p>To compare 30-day all-cause and cardiac-related mortality associated with DCA in VAF and VACC.</p> Design <p>Retrospective cohort study with pooled cross-sectional analysis.</p> Participants <p>VA patients who lived in the USA and underwent outpatient DCA in VAF or VACC between October 2015 and June 2019 (<i>N</i> = 31,640) were matched on nine baseline characteristics: age, race, rurality, drive distance to nearest VA primary care site, history of ischemic heart disease, history of valvular disease, procedure fiscal year, insurance status, and Elixhauser comorbidity index. Analysis was conducted from 2023 to 2025. </p> Main Measures <p>Thirty-day all-cause and cardiac-related mortality. Average treatment outcomes of VACC were estimated using weighted regression adjustment to account for selection into VACC. Sub-analyses included regression models stratified by diagnosis of valvular disease and heart failure.</p> Key Results <p>Among 31,640 DCAs, 28.06% were performed through VACC. VACC and VAF DCAs were well-balanced. Overall, 30-day all-cause mortality was 0.96% (2.49% in VACC and 0.37% in VAF [SMD = 0.182]), and most were cardiac-related. Compared with those who underwent DCA at VAF, those who had DCA at VACC had greater odds of 30-day all-cause (aOR 6.918, 95% CI = 4.521, 10.586), cardiac-related (aOR 6.112, 95% CI 3.715, 10.055), and non-cardiac related (aOR 13.45, 95% CI 5.352, 33.801) mortality. In stratified models, VACC DCA was associated with greater odds of 30-day mortality for all subgroups.</p> Conclusions <p>Results highlight the need for further research regarding strategies to improve follow-up and outcomes for VA patients undergoing DCA, particularly in VACC settings.</p>

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Comparison of 30-Day Mortality After Diagnostic Coronary Angiography at VA and Community Hospitals

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Denise M. Hynes,
  • Diana J. Govier,
  • Alex Hickok,
  • Meike Niederhausen,
  • Mazhgan Rowneki,
  • Howard S. Gordon,
  • Taisei Kobayashi

摘要

Background

The US Department of Veterans Affairs (VA) delivers care in its own facilities (VAF) and purchases community care (VACC) for some services including diagnostic coronary angiography (DCA). Whether patients experience comparable outcomes for DCA through VAF and VACC is unknown.

Objective

To compare 30-day all-cause and cardiac-related mortality associated with DCA in VAF and VACC.

Design

Retrospective cohort study with pooled cross-sectional analysis.

Participants

VA patients who lived in the USA and underwent outpatient DCA in VAF or VACC between October 2015 and June 2019 (N = 31,640) were matched on nine baseline characteristics: age, race, rurality, drive distance to nearest VA primary care site, history of ischemic heart disease, history of valvular disease, procedure fiscal year, insurance status, and Elixhauser comorbidity index. Analysis was conducted from 2023 to 2025.

Main Measures

Thirty-day all-cause and cardiac-related mortality. Average treatment outcomes of VACC were estimated using weighted regression adjustment to account for selection into VACC. Sub-analyses included regression models stratified by diagnosis of valvular disease and heart failure.

Key Results

Among 31,640 DCAs, 28.06% were performed through VACC. VACC and VAF DCAs were well-balanced. Overall, 30-day all-cause mortality was 0.96% (2.49% in VACC and 0.37% in VAF [SMD = 0.182]), and most were cardiac-related. Compared with those who underwent DCA at VAF, those who had DCA at VACC had greater odds of 30-day all-cause (aOR 6.918, 95% CI = 4.521, 10.586), cardiac-related (aOR 6.112, 95% CI 3.715, 10.055), and non-cardiac related (aOR 13.45, 95% CI 5.352, 33.801) mortality. In stratified models, VACC DCA was associated with greater odds of 30-day mortality for all subgroups.

Conclusions

Results highlight the need for further research regarding strategies to improve follow-up and outcomes for VA patients undergoing DCA, particularly in VACC settings.