Inpatient and follow-up cardiology care and mortality for acute coronary syndrome patients in the Veterans Health Administration

Background: The impact of inpatient and follow-up cardiology care on patient outcomes after acute coronary syndrome (ACS) hospital discharge is unknown. Methods: This was a retrospective cohort study of all patients with ACS discharged from Veterans Health Administration facilities from 2003 to 2004. Patients were stratified into 2 categories of cardiology care: (1) inpatient and follow-up cardiology care within 60 days after discharge and (2) other levels of cardiology care (inpatient only, outpatient only, and neither inpatient nor outpatient). Multivariable regression assessed the association between inpatient and follow-up cardiology care with all-cause mortality, adjusting for demographics, comorbidities, hospital presentation and treatment variables, and clustering by site. Results: Of 4933 patients with ACS, the majority (71.6%) had inpatient and follow-up cardiology care. Patients with inpatient and follow-up cardiology care were more likely to have prior coronary disease and diabetes and to present with myocardial infarction (vs unstable angina). All-cause mortality was lower for patients with inpatient and follow-up cardiology care (18.8% vs 22.1%, P = .009). In multivariable analysis, patients with inpatient and follow-up cardiology care remained at lower mortality risk (hazard ratio 0.73, 95% CI 0.62-0.87) compared with patients with other levels of cardiology care. The findings were consistent when cardiology follow-up was defined as 30 or 90 days after hospital discharge. Conclusions: Patients with inpatient and follow-up cardiology care have lower mortality risk after ACS. Future studies should identify mediators of this potential benefit and determine if interventions enhancing continuity of care in general, and continuity of subspecialty care in particular, after ACS will improve patient outcomes.