• Linda G Jones, Mo-Kyung Sin, Fadi G Hage, Raya E Kheirbek, Charity J Morgan, Michael R Zile, Wen-Chih Wu, Prakash Deedwania, Gregg C Fonarow, Wilbert S Aronow, Sumanth D Prabhu, Ross D Fletcher, Ali Ahmed, and Richard M Allman.
• From the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
• Circ Heart Fail. 2015 Jan 1; 8 (1): 17-24.

BackgroundCharacteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported.Methods And ResultsIn the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ≤35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94-1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86-1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80-1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant.ConclusionsPatients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals.Clinical Trial Registration Urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00000560.© 2014 American Heart Association, Inc.

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