Dharam J Kumbhani1, Gregg C Fonarow2, Christopher P Cannon3, Adrian F Hernandez4, Eric D Peterson4, W Frank Peacock5, Warren K Laskey6, Prakash Deedwania7, Maria Grau-Sepulveda4, Lee H Schwamm8, Deepak L Bhatt3. 1. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas. Electronic address: dharam@post.harvard.edu. 2. UCLA Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, Calif. 3. Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass. 4. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 5. Emergency Medicine, Baylor College of Medicine, Houston, Tex. 6. Division of Cardiology, University of New Mexico, Albuquerque. 7. Division of Cardiology, University of California, San Francisco. 8. Department of Neurology, Massachusetts General Hospital, Boston.
Abstract
BACKGROUND: Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing coronary artery bypass graft surgery, 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: By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 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, and use of lipid-lowering medications) in eligible patients with coronary artery disease 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 to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of prevention measures at all time points (P < .0001). Likewise, 100% adherence to all 6 measures was superior in the percutaneous coronary intervention group at all time points (P < .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.
BACKGROUND: Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing coronary artery bypass graft surgery, 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: By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 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, and use of lipid-lowering medications) in eligible patients with coronary artery disease 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 to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of prevention measures at all time points (P < .0001). Likewise, 100% adherence to all 6 measures was superior in the percutaneous coronary intervention group at all time points (P < .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.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Jari Heiskanen; Juha Hartikainen; Janne Martikainen; Heikki Miettinen; Mikko Hippeläinen; Risto P Roine; Anna-Maija Tolppanen Journal: Eur J Clin Pharmacol Date: 2019-10-11 Impact factor: 2.953
Authors: Jay R Desai; Gabriela Vazquez-Benitez; Zhiyuan Xu; Emily B Schroeder; Andrew J Karter; John F Steiner; Gregory A Nichols; Kristi Reynolds; Stanley Xu; Katherine Newton; Ram D Pathak; Beth Waitzfelder; Jennifer Elston Lafata; Melissa G Butler; H Lester Kirchner; Abraham Thomas; Patrick J O'Connor Journal: Circ Cardiovasc Qual Outcomes Date: 2015-09
Authors: Majid Ezzati; Ziad Obermeyer; Ioanna Tzoulaki; Bongani M Mayosi; Paul Elliott; David A Leon Journal: Nat Rev Cardiol Date: 2015-06-16 Impact factor: 32.419
Authors: Matthew D Solomon; Thomas K Leong; Eleanor Levin; Jamal S Rana; Marc G Jaffe; Stephen Sidney; Sue Hee Sung; Catherine Lee; Anthony DeMaria; Alan S Go Journal: J Am Heart Assoc Date: 2020-03-05 Impact factor: 5.501
Authors: José-Luis López-Sendón; José Ramón González-Juanatey; Fausto Pinto; José Cuenca Castillo; Lina Badimón; Regina Dalmau; Esteban González Torrecilla; José Ramón López Mínguez; Alicia M Maceira; Domingo Pascual-Figal; José Luis Pomar Moya-Prats; Alessandro Sionis; José Luis Zamorano Journal: Eur Heart J Date: 2015-10-21 Impact factor: 29.983