Cause of death in Washington state veterans hospitalized with acute coronary syndromes in the veterans health administration

Charles Maynard¹^,2 , Elliott Lowy¹^,2 , Mary McDonell¹ and Stephan D Fihn¹^,2^,3

¹Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA

²Department of Health Services, University of Washington, Seattle, WA, USA

³Department of Medicine, University of Washington, Seattle, WA, USA

author email corresponding author email

Population Health Metrics 2008, 6:3doi:10.1186/1478-7954-6-3


Published:	23 July 2008

Abstract

Background

In the United States, relatively little is known about cause of death in individuals who die prior to or after hospital discharge for acute coronary syndromes (ACS). The purpose of this report was to compare baseline patient characteristics according to whether the underlying cause of death was cardiac or non-cardiac.

Methods

We linked cause of death information from Washington State death records to the Department of Veterans Affairs (VA) External Peer Review Program ACS registry. From 524 individuals who were hospitalized for ACS in veterans hospitals located in Washington State or Oregon, we identified 136 individuals who according to VA death records died during the years 2003 to 2005. Of these, 117 (86%) were found in Washington State death records. Sociodemographic variables, as well as underlying and secondary causes of death, were obtained from Washington State death records provided by the Washington State Department of Health. Clinical variables, including medical histories, presentation on admission, and in-hospital death were extracted from the VA ACS registry.

Results

Somewhat surprisingly, only 52% of veterans died of cardiac causes when only the underlying cause of death was used. However, when secondary causes of death were added to the definition, the proportion that died of cardiac causes increased to 81%. Patient characteristics were similar in the two groups, although small numbers limited the ability to detect statistically significant differences.

Conclusion

These preliminary findings suggest that it is important to consider secondary causes as well as the underlying one when classifying deaths as cardiac or non-cardiac.