San Francisco Veterans Affairs Medical Center, San Francisco, California.
Icahn School of Medicine at Mount Sinai St Luke's and Mount Sinai West, New York, New York.
JAMA Netw Open. 2020 Mar 2;3(3):e201396. doi: 10.1001/jamanetworkopen.2020.1396.
Participation in cardiac rehabilitation (CR) programs at Veterans Affairs (VA) facilities is low. Most veterans receive CR through purchased care at non-VA programs. However, limited literature exists on the comparison of outcomes between VA and non-VA CR programs.
To compare 1-year mortality and 1-year readmission rates for myocardial infarction or coronary revascularization between VA vs non-VA CR participants.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 7320 patients hospitalized for myocardial infarction or coronary revascularization at the VA between 2010 and 2014 who did not die within 30 days of discharge and who participated in 2 or more CR sessions after discharge. The study excluded individuals hospitalized for ischemic heart disease after December 2014 when the VA Choice Act changed referral criteria for non-VA care. Data analysis was performed from November 2019 to January 2020.
Participation in 2 or more CR sessions within 12 months of discharge at a VA or non-VA facility.
The 1-year all-cause mortality and 1-year readmission rates for myocardial infarction or coronary revascularization from date of discharge were compared between VA vs non-VA CR participants using Cox proportional hazards models with inverse probability treatment weighting.
The 7320 veterans with ischemic heart disease who participated in CR programs had a mean (SD) age of 65.13 (8.17) years and were predominantly white (6005 patients [82.0%]), non-Hispanic (6642 patients [91.0%]), and male (7191 patients [98.2%]). Among these 7320 veterans, 2921 (39.9%) attended a VA facility, and 4399 (60.1%) attended a non-VA CR facility. Black and Hispanic veterans were more likely to attend CR programs at VA facilities (509 patients [17.4%] and 378 patients [12.9%], respectively), whereas white veterans were more likely to attend CR programs at non-VA facilities (3759 patients [85.5%]). After inverse probability treatment weighting, rates of 1-year mortality were 1.7% among VA CR participants vs 1.3% among non-VA CR participants (hazard ratio, 1.32; 95% CI, 0.90-1.94; P = .15). Rates of readmission for myocardial infarction or revascularization during the 12 months after discharge were 4.9% among VA CR participants vs 4.4% among non-VA CR participants (hazard ratio, 1.06; 95% CI, 0.83-1.35; P = .62).
These findings suggest that rates of 1-year mortality and 1-year readmission for myocardial infarction or revascularization did not differ for participants in VA vs non-VA cardiac rehabilitation programs. Eligible patients with ischemic heart disease should participate in CR programs regardless of where they are provided.
退伍军人事务部（VA）设施中的心脏康复（CR）计划参与率较低。大多数退伍军人通过非 VA 计划购买的护理接受 CR。然而，VA 和非 VA CR 项目之间的结果比较的文献有限。
比较 VA 与非 VA CR 参与者的心肌梗死或冠状动脉血运重建 1 年死亡率和 1 年再入院率。
设计、设置和参与者：这项队列研究包括 2010 年至 2014 年在 VA 住院治疗心肌梗死或冠状动脉血运重建且出院后 30 天内未死亡且出院后参加 2 次或以上 CR 课程的 7320 名患者。该研究排除了 2014 年 12 月之后因 VA 选择权法案改变非 VA 护理转介标准而因缺血性心脏病住院的患者。数据分析于 2019 年 11 月至 2020 年 1 月进行。
在 VA 或非 VA 设施中出院后 12 个月内参加 2 次或更多 CR 课程。
使用 Cox 比例风险模型和逆概率治疗加权法，比较 VA 与非 VA CR 参与者的出院后 1 年全因死亡率和心肌梗死或冠状动脉血运重建的 1 年再入院率。
参与 CR 项目的 7320 名缺血性心脏病患者的平均（SD）年龄为 65.13（8.17）岁，主要为白人（6005 例[82.0%]）、非西班牙裔（6642 例[91.0%]）和男性（7191 例[98.2%]）。在这 7320 名退伍军人中，2921 名（39.9%）参加了 VA 设施，4399 名（60.1%）参加了非 VA CR 设施。黑人和西班牙裔退伍军人更有可能参加 VA 设施的 CR 项目（分别为 509 名[17.4%]和 378 名[12.9%]），而白人退伍军人更有可能参加非 VA 设施的 CR 项目（3759 名[85.5%]）。经过逆概率治疗加权后，VA CR 参与者的 1 年死亡率为 1.7%，而非 VA CR 参与者的死亡率为 1.3%（风险比，1.32；95%CI，0.90-1.94；P = .15）。出院后 12 个月内因心肌梗死或血运重建再次入院的发生率在 VA CR 参与者中为 4.9%，而非 VA CR 参与者中为 4.4%（风险比，1.06；95%CI，0.83-1.35；P = .62）。
这些发现表明，VA 与非 VA 心脏康复项目参与者的 1 年死亡率和 1 年心肌梗死或血运重建再入院率没有差异。有缺血性心脏病的合格患者应参加 CR 项目，无论这些项目在哪里提供。
