doi: 10.1161/CIRCULATIONAHA.106.681247
(Circulation. 2007;116:I-207 – I-212.)
© 2007 American Heart Association, Inc.
Surgery for Coronary Artery Disease |
Atherosclerosis Secondary Prevention Performance Measures After Coronary Bypass Graft Surgery Compared With Percutaneous Catheter Intervention and Nonintervention Patients in the Get With the Guidelines Database
From the Cardiac Vascular and Thoracic Surgeons, Inc. and TriHealth, Inc. (Bethesda North and Good Samaritan Hospitals) (L.F.H.), Cincinnati, Ohio; University of Michigan, Ann Arbor (K.A.E.); Duke Clinical Research Institute (L.L., E.D.P.), Duke University Medical Center, Durham, NC; Division of Cardiology (G.C.F.), David Geffen School of Medicine at University of California, Los Angeles; and Masspro (K.A.L.), Waltham, Mass.
Correspondence to Loren F. Hiratzka, MD, Cardiac Surgery, Administration, 10500 Montgomery Rd, Cincinnati, OH 45242. E-mail loren_hiratzka{at}trihealth.com
Background— The American Heart Association Get With the Guidelines-Coronary Artery Disease program facilitates patient and physician compliance with proven atherosclerosis risk reduction strategies with collaborative learning sessions, teaching materials, predischarge online check lists, and web-based performance measure feedback for continuous quality improvement. Patients having coronary artery bypass graft surgery (CABG) may be subject to different care processes, nursing unit pathways, and personnel than patients having percutaneous catheter intervention or neither intervention, which may affect compliance.
Methods and Results— The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with secondary prevention performance measures for CABG patients was different from that for nonsurgical patients. A total of 119 106 patients were treated with CABG (14 118), percutaneous catheter intervention (58 702), or neither intervention (46 286). Compliance with medication prescriptions, including aspirin, ß-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs, and smoking cessation counseling for eligible patients was analyzed. Medically appropriate exclusions and contraindications were included in the analysis. After adjusting for 14 clinical variables, CABG patients were less likely to receive most secondary prevention measures relative to percutaneous catheter intervention patients. In contrast, CABG patients were more likely to receive aspirin, ß-blocker, and smoking cessation counseling than neither intervention patients. Composite adherence and defect-free rates were highest for percutaneous catheter intervention patients and lowest for neither intervention patients after adjustment.
Conclusions— There are significant differences in compliance at hospital discharge with secondary prevention performance measures for CABG patients compared with nonsurgical patients. Process of care differences may explain these differences and should be examined further because significant opportunities for improved compliance are evident. CABG patients in particular represent a group for whom secondary prevention has proven benefits, and they may benefit from future quality improvement interventions.
Key Words: secondary prevention • compliance/adherence • CV surgery • coronary artery disease • catheter-based coronary interventions