Temporal trends for secondary prevention measures among patients hospitalized with coronary artery disease
Dharam J Kumbhani1, Gregg C Fonarow2, Christopher P Cannon3
1Division of Cardiology, University of Texas Southwestern Medical Center, Dallas.
Insights
Adherence to secondary prevention measures for coronary artery disease improved over time for all treatment groups. However, patients receiving percutaneous coronary intervention showed higher adherence compared to coronary artery bypass graft surgery or no intervention.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Quality Improvement
Background:
- In-hospital adherence to secondary prevention varies among patients with coronary artery disease (CAD).
- Previous studies highlighted disparities in care for patients undergoing coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention.
- Contemporary trends in CAD management require investigation.
Purpose of the Study:
- To examine temporal trends in the in-hospital management of patients with coronary artery disease.
- To compare adherence to secondary prevention measures across different revascularization strategies.
- To identify opportunities for improving quality of care in CAD patients.
Main Methods:
- Utilized data from the Get With The Guidelines-Coronary Artery Disease registry (2003-2008).
- Compared adherence to 6 key performance measures in patients undergoing coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention.
- Adjusted for patient case-mix using multivariable analysis.
Main Results:
- Overall adherence to 6 quality measures improved across all treatment groups.
- Percutaneous coronary intervention group demonstrated superior adherence compared to coronary artery bypass graft surgery and no intervention groups.
- Significant differences in adherence persisted after multivariable adjustment.
Conclusions:
- In-hospital adherence to secondary prevention measures for CAD has significantly improved over the past decade.
- Adherence rates differ based on revascularization strategy, with percutaneous coronary intervention showing the highest rates.
- Opportunities remain to enhance adherence, especially for 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.
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