Transitions of Care Among Patients Undergoing Percutaneous Coronary Intervention for Stable Angina: Insights From the Veterans Affairs Clinical Assessment Reporting and Tracking Program

Author:

Waldo Stephen W.123ORCID,Glorioso Thomas J.1,Barón Anna E.4,Doll Jacob A.56ORCID,Plomondon Mary E.1,Ho P. Michael23

Affiliation:

1. VHA Office of Quality and Patient Safety Washington DC

2. Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO

3. Department of Medicine, Division of Cardiology University of Colorado School of Medicine Aurora CO

4. Department of Biostatistics and Informatics Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora CO

5. Puget Sound VA Medical Center Seattle WA

6. Department of Medicine University of Washington Seattle WA

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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