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Are we negating the benefits of CABG by forgetting secondary prevention?
1Department of Cardiac Surgery, University of Glasgow, Glasgow, UK.
Insights
Secondary prevention after coronary artery bypass grafting (CABG) was inadequately implemented one year post-surgery. Despite improvements in some areas, medication adherence and overall effectiveness were suboptimal, indicating a need for improved patient management strategies.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Secondary Prevention
Background:
- Coronary artery bypass grafting (CABG) is a major cardiovascular intervention.
- Effective secondary prevention is crucial for long-term patient outcomes post-CABG.
- Assessing adherence to secondary prevention guidelines is vital for patient health.
Purpose of the Study:
- To evaluate the effectiveness of medically managed secondary prevention strategies one year after coronary artery bypass grafting (CABG).
- To identify changes in medication use and symptom prevalence in patients post-CABG.
Main Methods:
- A cohort of 214 patients undergoing elective isolated CABG was studied.
- Patients were assessed four weeks preoperatively and one year post-operatively.
- Data collected included blood pressure, anginal symptoms, breathlessness, and medication usage.
Main Results:
- Systolic and diastolic blood pressure increased post-CABG, and anginal symptoms remained prevalent (45.1%).
- While breathlessness decreased, medication adherence for secondary prevention, including aspirin and nitrates, was lower postoperatively.
- Statin prescribing increased, leading to improved lipid profiles, but other key secondary prevention measures were underutilized.
Conclusions:
- Secondary prevention measures one year after CABG were poorly applied, less widespread, and less effective than preoperatively.
- Angina remains a common issue, highlighting gaps in postoperative care.
- The findings suggest disturbing implications for long-term cardiovascular health in post-CABG patients.
Unlabelled:
The objective of the study was to examine medically managed secondary prevention at one year after coronary artery bypass grafting (CABG). In all, 214 consecutive patients undergoing isolated elective CABG seen four weeks preoperatively and one year post-operatively. Preoperative systolic blood pressure averaged 135+/-20 mmHg, which increased to 148+/-25 mmHg (P<0.0001) as did diastolic pressure (81+/-12 to 87+/-13 mmHg; P<0.0001). Anginal symptoms were reported by 45.1% (P<0.0001) although median severity scored lower (4.0 [3.0-5.4] vs 0 [0-2.0]; P<0.0001). Breathlessness decreased from 93% to 64% (P<0.0001) and was scored less severely (4.0 [2.0-5.0] vs 2.0 [0-4.0]; P<0.0001. In all, 88% with postoperative angina reported dyspnoea against 44% of those without (P<0.0001). Calcium antagonist use was more common in patients with angina (27.2% vs 5.1%; P<0.0001), but not nitrates (P=0.8695), diuretics (P=0.4218), digoxin (P=0.2565), beta-blockers (P=0.0820), or ACE inhibitors (P=0.7256). Preoperatively 166 patients (80.2%) took aspirin vs 69.2% afterwards (P=0.0131). Twelve patients (6.5%) received warfarin after operation vs none preoperatively. Two took digoxin (0.97%) preoperatively and 14 (7.7%) postoperatively (P=0.001) for chronic atrial fibrillation. One of these took warfarin. Long-acting nitrate use fell from 63.4% to 15.8% (P <0.0001). Short-acting nitrate use fell similarly (P<0.0001). Preoperatively 37 patients (17.9%) took ACE inhibitors vs 44 postoperatively (24.2%); 39 had not received them before. Preoperatively 48 (23.2%) took diuretics vs 30 (16.5%) postoperatively (P=0.127); 24 had not previously taken diuretics. More patients took HMGCoA inhibitors postoperatively (P=0.0068) and total cholesterol was significantly reduced with a concomitant increase in HDL fraction. Smoking habit was virtually unchanged from 17.8% to 15.1% (P=0.5023).
In Conclusion:
angina was common. Apart from statin prescribing, postoperative secondary prevention measures were poorly applied, less widespread and less effective than preoperatively. The implications are disturbing.
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