Temporal trends for secondary prevention measures among patients hospitalized with coronary artery disease.
Am J Med. 2014 Nov 26;
Authors: Kumbhani DJ, Fonarow GC, Cannon CP, Hernandez AF, Peterson ED, Peacock WF, Laskey WK, Deedwania P, Grau-Sepulveda M, Schwamm LH, Bhatt DL, Get With the Guidelines Steering Committee and Investigators
BACKGROUND: Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing coronary artery bypass grafting, percutaneous coronary revascularization or no-intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease.
METHODS: Using data from the national GWTG-CAD registry, we sought to compare adherence with 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin converting enzyme inhibitor /angiotensin receptor blocker, smoking cessation counseling, use of lipid lowering medications) in eligible coronary artery disease patients who underwent coronary artery bypass graft surgery, percutaneous coronary intervention or no-intervention between 2003 and 2008.
RESULTS: A total of 113,971 patients with coronary artery disease were treated at 193 hospitals Overall adherence with all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in percutaneous coronary intervention patients compared with coronary artery bypass graft surgery patients; whereas no-intervention patients had the lowest use of prevention measures at all time points (p<0.0001) Similarly, 100% adherence to all 6 measures was superior in percutaneous coronary intervention patients at all time points (p<0.0001). On multivariable adjustment for case-mix of patients, the majority of these differences persisted.
CONCLUSIONS: Over the last decade, overall adherence with secondary prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no-intervention.
PMID: 25433302 [PubMed - as supplied by publisher]