doi: 10.1161/hc4901.100524
(Circulation. 2001;104:2898.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Comparison of Use of Medications After Acute Myocardial Infarction in the Veterans Health Administration and Medicare
From the Houston Center for Quality of Care and Utilization Studies, a Health Services Research and Development Center of Excellence; Houston VA Medical Center; and Section for Health Services Research, Baylor College of Medicine, Houston, Tex (L.A.P.); the Department of Health Care Policy, Harvard Medical School (S-L.T.N., B.J.M.), and the Department of Biostatistics (S-L.T.N.) and Department of Health Policy and Management (L.L.L.), Harvard School of Public Health, Boston, Mass; and the Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (B.J.M.).
Correspondence to Laura A. Petersen, MD, MPH, Health Services Research and Development (152), Houston Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030. E-mail laurap{at}bcm.tmc.edu
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, ß-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 ß-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.
Key Words: myocardial infarction • drugs • health care • thrombolysis
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