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A National Survey of Veterans Affairs Medical Centers’ Cardiology Services

A survey found that of cardiology services were widely available at facilities across the US Department of Veterans Affairs, but the types of services varied considerably based on facility complexity.
Federal Practitioner. 2019 November;36(7)s:S32-S36
November 6, 2019|Federal Practitioner
Lowell Chang, MD;Wade Brown, MD;Jason Carr, MD;Charles Lui, MD;Kimberly Selzman, MD;Caroline Milne, MD;John Nord, MD;Paul Eleazer, MD
Author and Disclosure Information

Lowell Chang is a Cardiologist and Associate Chief of Cardiology, Jason Carr is a Pulmonary Critical Care Fellow, Charles Lui is an Interventional Cardiologist, Kimberly Selzman is an Eletrophysiologist and Chief of Cardiology, Caroline Milne is an Internist and Residency Training Director for Internal Medicine, Paul Eleazer is a Hospitalist and Chief of Medicine, John Nord is an Internist and Deputy Chief of Staff, all at George E. Wahlen Veterans Administration Medical Center, Department of Internal Medicine in Salt Lake City, Utah. Wade Brown is a Pulmonary Critical Care Fellow at Vanderbilt University, Division of Pulmonary and Critical Care Medicine, Nashville, Tennessee. Lowell Chang is an Adjunct Instructor in the division of cardiovascular medicine, Jason Carr is a Pulmonary Critical Care Fellow, Charles Lui and Kimberly Selzman are Professors in the division of cardiovascular medicine, Caroline Milne is a Professor and Vice Chair for Education and Program Director of the Internal Medicine Training Program, John Nord is an Assistant Professor of Medicine, and Paul Eleazer is a Professor of Medicine, all at the University of Utah School of Medicine in Salt Lake City, Utah.
Correspondence: Lowell Chang (lowell.chang@hsc.utah.edu)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

Limitations

While this study provides background information that may be useful in comparing cardiology services between VA and non-VA systems, drawing causal relationships may not be warranted. For example, while the literature generally supports the concept of inpatient cardiology services led by an attending cardiologist, a substantial numbers of VA inpatient facilities have not yet adopted this model.4-6 Even among more complex, level 1 facilities, we found that only 31% offered both an inpatient CCU and floor team service led by an attending cardiologist physician. Thus, 69% of Level 1 facilities reported caring for patients with a primary cardiology problem through a noncardiology admitting services (with access to a cardiology consultation service). Additional studies should be conducted that would evaluate patient outcomes in relationship to the types of services available at a given VA medical center. Patient outcomes in relationship to service provision between the VA and non-VA health care systems also are warranted.

This study is limited by its reliance on self-reporting. Although we believe that we reached respondents who were qualified to complete the survey, the accuracy of reporting was not independently validated. Further, we asked questions about the most frequent models of cardiology care but may not have captured more novel methods. In trying to keep the survey time to < 2 minutes, we did not explore other details of cardiology services, such as the availability of a dedicated pharmacist, nor more advanced procedures such as transcatheter aortic valve replacement. Additionally, the present study is a snapshot of cardiology services for a given period, and, as noted above, did not look at patient outcomes. Further research is needed to determine which service provided is most beneficial or feasible in improving patient outcomes, which includes examining the various models of inpatient cardiology-led services for optimal care delivery.

Conclusion

Cardiology services were widely available throughout the VA system. However, the types of services available varied considerably. Predictably, facilities that were more complex generally had more advanced services available. Providing a general overview of how cardiovascular care is being delivered currently across VA systems helps to identify areas for optimization within VA facilities of various complexities with initiatives such as implementation of cardiology-led inpatient services, which may be beneficial in improving patient care outcomes as demonstrated previously in other large healthcare systems.

Acknowledgments
This material is the result of work supported with resources and use of the facilities at the George E. Wahlen Salt Lake City VA Medical Center. We are grateful to all of those who responded to our survey, and the support of the facility leadership. We are thankful for Tasia M. Nash and Tammy Jackson who helped to organize the data, and to Leigh Eleazer for her help in the manuscript preparation and formatting. 

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