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American Journal of Medical Quality, Vol. 14, No. 1, 55-63 (1999)
DOI: 10.1177/106286069901400108

Rates of Health Services Utilization and Survival in Patients with Heart Failure in the Department of Veterans Affairs Medical Care System

Carol M. Ashton, MD, MPH

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex, cashton{at}bcm.tmc.edu

Nancy J. Petersen, PhD

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

Julianne Souchek, PhD

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

Terri J. Menke, PhD

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

Kenneth Pietz, PhD

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

Hong-Jen Yu, MS

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

Nelda P. Wray, MD, MPH

Center for Quality of Care and Utilization Studies (a Veterans Affairs Health Services Research and Development Field Program), Houston, Tex, the VA Medical Center, Houston, Tex and the Baylor College of Medicine, Houston, Tex

The objective of this study was to describe patterns of hospital and clinic use and survival for a large nationwide cohort of patients with heart failure. A retrospective cohort study of patients treated in the Veterans Affairs medical care system was conducted using linked administrative databases as data sources. In 1996, the average heart failure cohort member had 1-2 hospitalizations, 14 inpatient days, 6-7 visits with the primary physician, 15 other visits for consultations or tests, and 1-2 urgent care visits per 12 months. The overall risk-adjusted 5-year survival rate was 36%. Hospital use rates in the cohort fell dramatically between 1992 and 1996. One-year survival rates increased slightly over the period. Patients with heart failure are heavy users of services and have a very poor prognosis. Utilization and outcome data indicate the need for major efforts to assure quality of care and to devise innovative ways of delivering comprehensive services.


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A. Deswal, N. J. Petersen, J. Souchek, C. M. Ashton, and N. P. Wray
Impact of race on health care utilization and outcomes in veterans with congestive heart failure
J. Am. Coll. Cardiol., March 3, 2004; 43(5): 778 - 784.
[Abstract] [Full Text] [PDF]