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(Circulation. 2003;108:II-24.)
© 2003 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Patterns of Secondary Prevention in Older Patients Undergoing Coronary Artery Bypass Grafting During Hospitalization for Acute Myocardial Infarction

JoAnne Micale Foody, MD; Francis D. Ferdinand, MD, FACC; Deron Galusha, MS; Saif S. Rathore, MPH; Frederick A. Masoudi, MD, MSPH; Edward P. Havranek, MD; David Nilasena, MD, MSPH; Martha J. Radford, MD, FACC; Harlan M. Krumholz, MD, FACC

From the Department of Internal Medicine, Sections of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT; Qualidigm, Middletown, CT; Colorado Foundation for Medical Care, Aurora, CO; Division of Cardiology, Denver Health Medical Center, Denver, CO; Lankanau Hospital, Wynnewood, PA; and The Centers for Medicare and Medicaid Services, Baltimore, MD

Correspondence to JoAnne Micale Foody, M.D., Yale School of Medicine, 333 Cedar Street, P.O. Box 208025, New Haven, CT 06520-8025. Phone: 203-785-4128; Fax: 203-785-7144; E-mail: joanne.foody{at}yale.edu

Background— Aggressive risk factor modification decreases cardiovascular events and mortality in patients after coronary artery bypass grafting (CABG). Little is known regarding the use of secondary prevention in older patients undergoing CABG during hospitalization for acute myocardial infarction (AMI).

Methods and Results— Medical records were reviewed for a sample of 37,513 patients hospitalized with AMI in the United States between April 1998 and March 1999. Patients 65 years of age who underwent CABG after AMI (n=2,267 [8%]) were evaluated for the prescription of 4 therapies at discharge: aspirin, ß-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lipid lowering, in eligible patients without contraindications to therapy and compared with patients who did not undergo CABG (n=26,484 [92%]). Patients undergoing CABG had higher rates of aspirin than patients who did not undergo CABG (88.0% versus 83.2%, P=0.0002). However, CABG patients were less likely to receive ß-blockers (61.5% versus 72.1%, P<0.0001), ACE inhibitors (55.5% versus 72.1%, P<0.0001), or lipid lowering (34.7% versus 55.7%, P<0.0001) prescriptions than patients who did not undergo CABG. After adjustment for disease severity, patients undergoing CABG were no longer more likely to receive discharge aspirin, and the magnitude of other differences in care increased.

Conclusions— Evidence-based discharge therapies are underutilized in older patients who underwent CABG during hospitalization for AMI. Although national efforts focusing on improving short-term surgical mortality have been successful, strategies should be developed to increase the utilization of therapies known to improve long-term mortality in patients undergoing CABG.

Key Words: heart surgery • risk factors • elderly • quality assessment

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