Journal of the American College of Cardiology  2014 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 63, No. 5, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.09.055

CLINICAL RESEARCH

Invasive Cardiology

Normal Coronary Rates for Elective Angiography in the Veterans Affairs Healthcare System Insights From the VA CART Program (Veterans Affairs Clinical Assessment Reporting and Tracking) Steven M. Bradley, MD, MPH,*yz Thomas M. Maddox, MD, MSC,*yz Maggie A. Stanislawski, MS,*z Colin I. O’Donnell, MS,*z Gary K. Grunwald, PHD,*yz Thomas T. Tsai, MD, MSC,*yz P. Michael Ho, MD, PHD,*yz Eric D. Peterson, MD, MPH,x John S. Rumsfeld, MD, PHD*yz Denver and Aurora, Colorado; and Durham, North Carolina Objectives

This study sought to determine if an integrated healthcare system is selective and consistent in the use of angiography, as reflected by normal coronary rates.

Background

Rates of normal coronary arteries with elective coronary angiography vary considerably among U.S. community hospitals. This variation may in part reflect incentives in fee-for-service care.

Methods

Using national data from the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program representing all 76 VA cardiac catheterization laboratories, we evaluated all patients who underwent elective coronary angiography from October 2007 to September 2010. Normal coronary angiography was defined as