By Lisa Rapaport

(Reuters Health) – Heart disease death rates vary substantially at Veterans Affairs hospitals nationwide, and a new study suggests that this holds true not just for hospitalized patients but also for outpatients.

Previous research has long documented differences in death rates at hospitals across the U.S., not just at VA facilities, often focusing on deaths among hospitalized patients or within a month after discharge. The current study, however, offers fresh insight by looking at combined mortality rates for inpatient and outpatient care.

Researchers studied 930,079 veterans with heart disease and 348,015 with congestive heart failure who received care at 138 VA health systems nationwide from 2010 to 2014.

At the various locations, annual death rates for heart disease ranged from a low of 5.5 percent to a high of 9.4 percent, while mortality rates for congestive heart failure ranged from 11.1 percent to 18.9 percent, researchers calculated.

“The quality of care for chronic heart disease may differ across hospitals, thus some hospitals may be better at providing continuity care to patients with chronic heart disease,” said lead study author Dr. Peter Groeneveld of the Corporal Michael J. Crescenz VA Medical Center in Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.

“There are also numerous evidence-based therapies that have been shown to reduce heart failure mortality, but the use of these therapies varies widely,” Groeneveld said by email.

The study wasn’t designed to prove how care provided at specific hospitals and clinics might directly contribute to mortality rates.

However, the variation in mortality rates at VA hospitals likely mirrors what’s would be seen at other hospitals and health systems, Groeneveld added. And some differences in patient populations that weren’t possible to measure in the study- like disease severity, frailty, dementia or socioeconomic status – might have influenced death rates, he said.

Millions of Americans have what’s known as ischemic heart disease, one of the two conditions examined in the study. It is caused by narrowed arteries that restrict blood flow to the heart and can ultimately lead to a heart attack.

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Congestive heart failure is also common. It happens when the heart muscle weakens and doesn’t pump blood as well as it should, and can be caused by narrowed arteries as well as by high blood pressure.

Patients with heart disease and congestive heart failure usually need regular clinic visits to monitor their blood pressure and assess other factors related to heart disease like cholesterol, weight, and smoking and drinking habits. Regular outpatient care can help improve patients’ quality of life and minimize their risk of hospitalization or death.

More than four in five patients in the study had high blood pressure, researchers report in JAMA Cardiology.

About half of them had diabetes, which can damage blood vessels and contribute to worse symptoms for people with heart disease or heart failure.

These patients with multiple chronic health problems have a high risk of serious complications and death. It’s not clear from the study results how much hospitals and clinics can control mortality rates, said, Dr. Paul Heidenreich of the VA Palo Alto Health Care System and Stanford University School of Medicine in California.

“Some of the difference in mortality may be due to differences in patients for which we can’t control (because we don’t have data systems to track them) and some may be due to differences in quality of care,” Heidenreich, author of an accompanying editorial, said by email.

“The study adds to this knowledge by showing that this variation in mortality is present for outpatients as well and extends well beyond 30 days (after patients leave the hospital),” Heidenreich added. “If the variation is due to differences in care, then knowing these differences will matter to patients and be important for the health care system to address.”

SOURCE: and JAMA Cardiology, online May 16, 2018.