Cardiovascular care delivered by the Veterans Healthcare Administration (VHA) is equivalent or better than that provided by non-VHA community care, according to a State-of-the-Art Review by the ACC Federal Cardiology Leadership Council published Jan. 20 in JACC: Advances.

Nearly 50% of veterans report having at least one cardiovascular disease, compared with 37% in non-veterans. The VHA is the largest integrated health care system in the U.S., with 172 medical centers containing 139 cardiology departments plus related services. Two pieces of legislation, the CHOICE and MISSION Acts, were passed in 2014 and 2018 respectively, to increase the use by veterans of non-VHA community care. This is defined as services delivered in non-VHA facilities by non-VHA providers and is authorized and paid for by the VHA. Criteria for specialty care are required service not offered at VHA, wait time more than 28 days and drive time more than 60 minutes.

In their review, D. Elizabeth Le, MD, FACC, et al., summarize studies with direct comparison of the quality and access to cardiovascular care delivered by VHA and community care between 2000 and 2024 in a PubMed literature search. Such a comparison is valuable, they state, to derive health care policy, share novel and effective quality initiatives throughout the health care sector, and help veterans and physicians make important health care decisions.

Key highlights from their review include:

• Veteran wait-time for VHA services is generally shorter than for community care services.
• Treatment for heart failure and acute myocardial infarction at VHA hospitals is associated with reduced mortality vs. community care.
• Mortality after elective PCI is lower for veterans treated at VHA vs. community facilities.
• TAVR outcomes are similar in VHA and non-VHA medical facilities.
• Two quality improvement programs developed by the VHA were effective in promoting quality and serve as models for care inside and outside the VHA.

The authors propose a roadmap to improve care and access in the VHA. They note that veterans having difficulty accessing care would experience greater health benefits by improving their access to the VHA rather than community care. They suggest telecardiology should be expanded, as well as additional in-person services in the VHA community-based outpatient clinics, and that transportation and hospitality services could be offered, and more.

"VHA should continue to collaborate with the Centers for Medicare and Medicaid Services to share clinical and outcomes data so that both VHA and veterans can compare hospital performance between VHA and non-VHA care facilities in their communities. These measures are important steps to assist the government in fulfilling its obligation to the veterans to provide optimal cardiovascular health care," they write.