VHA Office of Quality and Patient Safety Washington DC.
Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO.
J Am Heart Assoc. 2022 Feb 15;11(4):e024598. doi: 10.1161/JAHA.121.024598. Epub 2022 Feb 12.
Background Effective transitions from the procedural to outpatient setting are essential to ensure high-quality cardiovascular care across health care systems, particularly among patients undergoing invasive cardiac procedures. We evaluated the association of postprocedural follow-up visits and antiplatelet prescriptions with clinical outcomes among patients undergoing percutaneous coronary intervention for stable angina at community or Veterans Affairs (VA) hospitals. Methods and Results Patients who actively received care within the VA Healthcare System and underwent percutaneous coronary intervention for stable angina at a community or VA hospital between October 1, 2015, and September 30, 2019, were identified. We compared mortality for patients receiving community or VA care, and among subgroups of community-treated patients by the presence of a postprocedural follow-up visit within 30 days or prescription for antiplatelet (P2Y12) medication within 120 days of the procedure. Among 12 837 patients who survived the first 30 days, 5133 were treated at community hospitals, and 7704 were treated in the VA. Prescriptions for antiplatelet therapy were less common for those treated in the community (85%) compared with the VA at 1 year (95%; hazard ratio [HR], 0.46; 95% CI, 0.44-47). Compared with VA-treated patients, the hazards for death were similar for patients treated in the community with a follow-up visit (HR, 1.17; 95% CI, 0.97-1.40) or with a fill for an antiplatelet therapy (HR, 1.08; 95% CI, 0.90-1.30). However, patients treated in the community without a follow-up visit had an 86% (HR, 1.86; 95% CI, 1.40-2.48) increased hazard of death, and those without antiplatelet prescription fill had a 144% increased hazard of death (HR, 2.44; 95% CI, 1.85-3.21) compared with all VA-treated patients. Conclusions Patients treated at community facilities have a decreased chance of receiving antiplatelet prescriptions after percutaneous coronary intervention with a concordant increased hazard of mortality, emphasizing the importance of transitions of care across health care systems when assessing cardiovascular quality.
在医疗保健系统中，从程序到门诊的有效过渡对于确保高质量的心血管护理至关重要，尤其是在接受介入性心脏手术的患者中。我们评估了接受经皮冠状动脉介入治疗稳定型心绞痛的患者在社区或退伍军人事务部 (VA) 医院接受术后随访和抗血小板治疗的情况与临床结局的关系。
本研究纳入了 2015 年 10 月 1 日至 2019 年 9 月 30 日期间在退伍军人事务部医疗保健系统内积极接受治疗，并在社区或退伍军人事务部医院接受经皮冠状动脉介入治疗稳定型心绞痛的患者。比较了在社区或退伍军人事务部接受治疗的患者的死亡率，以及在社区治疗的患者中，术后 30 天内接受随访或术后 120 天内接受抗血小板（P2Y12）治疗的患者的亚组死亡率。在存活至术后 30 天的 12837 名患者中，5133 名在社区医院接受治疗，7704 名在退伍军人事务部接受治疗。与退伍军人事务部治疗组相比，社区治疗组接受抗血小板治疗的比例较低（85%比 1 年时的退伍军人事务部治疗组 95%；风险比 [HR]，0.46；95%CI，0.44-47）。与退伍军人事务部治疗组相比，接受随访的社区治疗患者（HR，1.17；95%CI，0.97-1.40）或接受抗血小板治疗的患者（HR，1.08；95%CI，0.90-1.30）的死亡风险相似。然而，未接受随访的社区治疗患者的死亡风险增加了 86%（HR，1.86；95%CI，1.40-2.48），未接受抗血小板处方治疗的患者的死亡风险增加了 144%（HR，2.44；95%CI，1.85-3.21），与所有退伍军人事务部治疗的患者相比。
在社区医疗机构接受治疗的患者在接受经皮冠状动脉介入治疗后接受抗血小板治疗的机会减少，而死亡率的相应增加，这强调了在评估心血管质量时，医疗保健系统之间的护理过渡的重要性。
