No 25-year payoff for early stents; VA covers more heart care in some Medicare Advantage plans; counties go green for Veterans Day — Morning Medical Update

No 25-year payoff for early stents

Long-term data from a VA trial still show no edge for stenting up front in stable heart disease.

Veterans with stable coronary artery disease who had percutaneous coronary intervention (PCI) up front on top of optimal medical therapy did no better over as long as 25 years than those who started on medical therapy alone, according to an extended follow-up of the COURAGE trial published Nov. 7 in JAMA and presented at the American Heart Association’s Scientific Sessions 2026 in Chicago. The post hoc analysis followed 959 veterans from 15 Department of Veterans Affairs (VA) hospitals for a median of 15 years.

The estimated 25-year rate of death or heart attack was 93.3% in the PCI group and 91% in the medical therapy group, a difference that was not statistically significant. More than half of veterans in each group had a revascularization procedure at some point during follow-up. The findings match the trial’s earlier results from 2007 and 2015, Healio reported.

VA covers more heart care in some Medicare Advantage plans

In plans heavy with veterans, the plan paid for far fewer cardiac hospital stays.

Medicare Advantage (MA) plans paid for 43.2% of cardiovascular hospitalizations among veterans in plans where at least 20% of members were veterans, compared with 69.2% among veterans in other MA plans, according to a study of 76,722 MA-enrolled veterans published Nov. 9 in Circulation: Population Health and Outcomes. In the veteran-heavy plans, the VA paid for community hospital care in 28.1% of cases and treated patients in its own hospitals in 28.7%, compared with 16% and 14.8% in other plans.

Because MA plans receive set monthly payments meant to cover inpatient care, the authors wrote that the results suggest the plans may be shifting costs to the VA, and they called for policy changes to cut duplicate federal spending. The cross-sectional study used 2021 data and cannot establish cause. An accompanying editorial called paying twice for veterans’ cardiac care a solvable problem.

Counties go green for Veterans Day

The weeklong campaign also points veterans to local help with their benefits.

If a courthouse or county building near your practice has been glowing green this week, here’s why. The National Association of Counties (NACo) and the National Association of County Veterans Service Officers invited the nation’s 3,069 counties, parishes and boroughs to light buildings and landmarks green from Nov. 4 through Veterans Day as part of Operation Green Light for Veterans, now in its sixth year. The goal, according to NACo, is to let veterans know they are “seen, appreciated and supported.”

Counties in 29 states also run locally funded veterans service offices that offer accredited help to veterans trying to reach the federal, state and local benefits they have earned, NACo says, which can make them a useful referral for patients who served. To the physicians who served: thank you.