Army Veteran Richard “Dick” Kamerling noticed he was slowing down. When he started feeling some pain in his chest, he knew it was time to see his cardiologist.
That would be Dr. Stephen Waldo, director of Interventional Cardiology at Rocky Mountain Regional VA Medical Center.
Kamerling served two tours in Vietnam as both a pilot and founding member of the elite Delta Force.
Army Veteran Dick Kamerling: “I have absolute confidence in Dr. Waldo and knew he would take care of me.”
“When Dr. Waldo said I needed a stent to open my arteries, it was a done deal. I have absolute confidence in him and knew he would take care of me,” Kamerling said. “He goes the extra mile.”
Over 10,000 Veterans have procedure every year
When Kamerling had his surgery two years ago to place a stent in the artery to his heart, he became one of about 10,000 to 12,000 Veterans a year that have the procedure done at a VA hospital. The procedure, also called Percutaneous Coronary Intervention (PCI), involves expanding a heart artery, often with a tube and metal mesh scaffold to increase blood flow to a restricted or blocked artery.
This is a very common procedure, but it does have some risk. A study was recently published in the Journal of the American Heart Association that evaluated Veterans undergoing this procedure at community or VA hospitals. Over a four-year period (October 2015 – September 2019), 12,962 Veterans underwent this procedure electively to improve their symptoms.
One year after the procedure, those treated at a VA facility had an approximately 25% lower risk of complications compared to those treated at a community hospital.
As one of the authors of the study, Waldo noted that the differences in outcomes were immediate, suggesting differences in procedural techniques. However, the increase in complication rates at community hospitals also expanded over time indicating that the follow-up-care that these patients received was also different.
Biggest differences included intensity of follow-up visits
“Both groups of Veterans had very similar characteristics based on age, race and medical history,” Waldo said. “The biggest differences we found after the procedure were the intensity of follow-up visits and appropriate medication prescriptions. Veterans treated at a VA facility were much more likely to have regular follow-up with their physician and receive appropriate medications afterward. Both factors reduce the risk of a future heart attack.”
Although the study didn’t identify all causes of improved outcomes at VA hospitals, Waldo does have some theories. “The majority of interventional cardiologists at VA are also associated with an academic institution. This gives them access to the latest techniques and best practices in cardiac care,” Waldo said. He is also an Associate Professor at the University of Colorado, School of Medicine in Denver.
“Also, for those who get most of their care at VA, there is a continuity that may allow closer tracking of patient care,” Waldo added. Other studies have indicated that Veterans who receive their health care from the VA generally have better outcomes than those in community care.
Quarterly case conferences keep VA cardiologists updated
To ensure VA cardiologists are knowledgeable of the latest techniques, best practices and medications, they conduct quarterly case conferences and provide updates to the cardiac team, including doctors, nurses and technicians. They also have access to online case reviews to keep their skills current.
These efforts are invisible to Veterans. They just know how they are treated at VA and if they feel valued and well cared for.
“I wish I could get all of my care from VA,” Kamerling said. “I have had some really good doctors and when I go to VA, I have something in common with every single person there.”