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Published on: March 15, 2022
Interventions to improve guideline compliance following coronary artery bypass grafting
Felix K Yam1, Wendell S Akers, Victor A Ferraris
1Department of Pharmacy Services, Kentucky Chandler Medical Center, University of Kentucky, Lexington, KY, USA.
Insights
Post-coronary artery bypass grafting (CABG) care often lacks guideline adherence. A multidisciplinary intervention significantly improved compliance with evidence-based recommendations for better patient outcomes.
Area of Science:
- Cardiology
- Evidence-based medicine
- Healthcare quality improvement
Background:
- Long-term outcomes after coronary artery bypass grafting (CABG) depend on lifestyle modifications and medical therapy.
- Evidence suggests suboptimal adherence to post-discharge guidelines in CABG patients.
- This study aimed to quantify guideline compliance and address deficiencies in discharge practices.
Purpose of the Study:
- To document the rate of compliance with evidence-based guidelines after CABG.
- To implement and evaluate interventions to improve adherence to discharge recommendations.
- To enhance long-term patient outcomes through improved post-operative care.
Main Methods:
- Evaluated compliance with seven key interventions: beta-blockers, ACE inhibitors, aspirin, lipid-lowering therapy, smoking cessation, heart-healthy diet, and physical activity.
- Assessed compliance in a control group (n=50) before interventions.
- Implemented a multidisciplinary team-led intervention program.
- Prospectively assessed compliance in a subsequent study group (n=50) after interventions.
Main Results:
- Initial compliance with evidence-based guidelines in the control group was found to be low.
- Following the multidisciplinary intervention, rates of guideline compliance significantly increased.
- The intervention effectively improved the provision of medications and lifestyle counseling at discharge.
Conclusions:
- Compliance with guidelines crucial for long-term outcomes after CABG is often suboptimal.
- A multidisciplinary intervention program is effective in improving adherence to evidence-based guidelines and quality indicators in post-CABG patients.
Background:
Lifestyle modification and appropriate medical therapy improve long-term outcomes following coronary artery bypass grafting (CABG). Our institutional experience suggested that evidence-based recommendations were not being followed postdischarge after CABG. We undertook this study to document our rate of compliance with evidence-based guidelines and to correct deficiencies in our discharge practices.
Methods:
Seven evidence-based interventions were studied after CABG: (1) institution of beta-blocker therapy, (2) angiotensin-converting enzyme (ACE) inhibitor therapy, (3) aspirin, (4) lipid-lowering therapy, (5) smoking cessation intervention, (6) heart-healthy diet therapy, and (7) physical activity recommendations. The rate of compliance with guidelines in 50 control patients was measured at discharge. A multidisciplinary team including cardiac surgeons, nurses, dieticians, physical therapists, and clinical pharmacists evaluated the guideline compliance in the control group and developed interventions to assure guideline compliance at the time of discharge. A subsequent study group of 50 patients was then assessed prospectively to measure the guideline compliance after institution of intervention programs. The multidisciplinary team agreed on predefined acceptable compliance limits as follows: (1) >80% of patients receive ACE inhibitors at discharge, (2) 100% of patients receive beta-blockers, aspirin, and lipid-lowering agents at discharge, and (3) 100% of patients receive lifestyle modification counseling at discharge. Compliance with guidelines was defined as documentation in the medical record of provision of medications and lifestyle counseling at the time of discharge.
Results:
In the control group, the rate of guideline compliance was surprisingly low. Rates of compliance with guidelines increased significantly after the multidisciplinary interventions were undertaken.
Conclusions:
We conclude that compliance with guidelines known to improve long-term outcome is suboptimal after CABG. A multidisciplinary intervention program can improve compliance with currently accepted guidelines and quality indicators in patients following CABG.
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