TY - JOUR
AU - S. W. Waldo
AU - T. J. Glorioso
AU - N. Butala
AU - P. Varosy
AU - C. S. Duvernoy
AU - M. E. Plomondon
AU - J. Francis
A1 - 
AB - BACKGROUND: The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model. METHODS: We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed. The primary outcome was major adverse cardiovascular events (acute coronary syndromes/stroke/mortality) in a matched population. RESULTS: Among 235 197 consultations for cardiovascular evaluation, 201 453 were completed in the chosen venue within 6 months. The time between consultation and evaluation was similar across venues (community, 35 days [95% CI, 17-65] versus VA, 33 days [95% CI, 19-53]), with comparable delays to diagnostic testing or therapeutic interventions. Patients receiving care in the community were more likely to undergo stress testing (43.2% versus 36.4%, P=1.5×10(-46)) and coronary angiography (23.1% versus 17.4%, P=2.1×10(-51)) within 2 years compared with those treated in the VA Healthcare System. Despite this, patients treated in the community had a significantly higher rate of major adverse events at 2 years (17.6% versus 15.3%, P=5.9×10(-10)) compared with those treated in the VA Healthcare System. CONCLUSIONS: Patients undergoing cardiovascular evaluation in community practices were not evaluated more rapidly than those seen in the VA, though they were more likely to receive initial and repeat diagnostic testing. Adverse events were more common among community-treated patients than those in the VA, suggesting an opportunity to optimize access to care while improving clinical outcomes.
AD - CART Program, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA.; Rocky Mountain Regional Veterans Affairs Medical Center Aurora CO USA.; Division of Cardiology, Department of Medicine University of Colorado Aurora CO USA.; National Cardiology Program, Specialty Care Program Office Veterans Health Administration Washington DC USA.; Division of Cardiology, Department of Medicine University of Michigan Ann Arbor MI USA.; VA Ann Arbor Healthcare System Ann Arbor MI USA.; Analytics and Performance Integration, Office of Quality and Patient Safety Veterans Health Administration Washington DC USA.
AN - 40676876
BT - J Am Heart Assoc
C5 - Healthcare Disparities
CP - 15
DA - Aug 5
DO - 10.1161/jaha.125.041930
DP - NLM
ET - 20250717
IS - 15
JF - J Am Heart Assoc
LA - eng
N2 - BACKGROUND: The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model. METHODS: We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed. The primary outcome was major adverse cardiovascular events (acute coronary syndromes/stroke/mortality) in a matched population. RESULTS: Among 235 197 consultations for cardiovascular evaluation, 201 453 were completed in the chosen venue within 6 months. The time between consultation and evaluation was similar across venues (community, 35 days [95% CI, 17-65] versus VA, 33 days [95% CI, 19-53]), with comparable delays to diagnostic testing or therapeutic interventions. Patients receiving care in the community were more likely to undergo stress testing (43.2% versus 36.4%, P=1.5×10(-46)) and coronary angiography (23.1% versus 17.4%, P=2.1×10(-51)) within 2 years compared with those treated in the VA Healthcare System. Despite this, patients treated in the community had a significantly higher rate of major adverse events at 2 years (17.6% versus 15.3%, P=5.9×10(-10)) compared with those treated in the VA Healthcare System. CONCLUSIONS: Patients undergoing cardiovascular evaluation in community practices were not evaluated more rapidly than those seen in the VA, though they were more likely to receive initial and repeat diagnostic testing. Adverse events were more common among community-treated patients than those in the VA, suggesting an opportunity to optimize access to care while improving clinical outcomes.
PY - 2025
SN - 2047-9980
SP - e041930
ST - Management and Outcomes of Patients Undergoing Cardiovascular Evaluation Across Health Care Systems: Comparison of Community Care and Integrated Veterans Affairs Health Care
T1 - Management and Outcomes of Patients Undergoing Cardiovascular Evaluation Across Health Care Systems: Comparison of Community Care and Integrated Veterans Affairs Health Care
T2 - J Am Heart Assoc
TI - Management and Outcomes of Patients Undergoing Cardiovascular Evaluation Across Health Care Systems: Comparison of Community Care and Integrated Veterans Affairs Health Care
U1 - Healthcare Disparities
U3 - 10.1161/jaha.125.041930
VL - 14
VO - 2047-9980
Y1 - 2025
ER -