Abstract 3733: Long-Term Adherence to the ACC/AHA Class I Post-Discharge Medications and Recommendations Using Optimal Medical Therapy in 2,287 Patients with Established Coronary Heart Disease: Interim Data from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial
Background: Despite scientific evidence from multiple randomized controlled trials that individual secondary prevention interventions reduce morbidity and mortality, few studies have evaluated the long-term impact of multiple ACC/AHA recommended therapies in patients with established coronary heart disease (CHD). We, therefore, sought to compare adherence to comprehensive treatment guidelines at baseline and at 60 months of follow-up in this long-term CHD trial.
Methods: COURAGE is a large multicenter North American trial comparing percutaneous coronary intervention plus aggressive medical therapy versus aggressive medical therapy alone during a median 5 year follow-up. Medical therapy in both arms conforms with current ACC/AHA treatment guidelines and includes aspirin, clopidogrel, long-acting metoprolol and/or amlodipine, lisinopril or losartan, and simvastatin. Treatment targets include systolic (S) and diastolic (D) BP<130/85 mm Hg, LDL-cholesterol 60–85 mg/dL, AHA step II diet, and exercise 5 times/week. Medical therapy and multiple risk factor interventions are protocol-driven and intensively case-managed by nurse coordinators at the 50 paricipating U.S. and Canadian enrolling sites.
Results: Compared to baseline rates of therapy, data at 60 months show improvement in the use of anti-platelet agents (91% vs 97%), beta blockers (73% vs 86%), antihypertensive agents (ACE inhibitors 49% vs 69%, calcium blockers 31% vs 49%, and angiotensin II receptor blockers 4% vs 12%), and statins (71% vs 97%). There was also substantial improvement in achieving pre-defined treatment targets at follow-up for LDL (25% vs 70%), SBP (39% vs 65%), DBP (81% vs 94%), AHA step II diet (51% vs 76%), and exercise (23% vs 38%) when compared to baseline data.
Conclusions: Increased adherence to ACC/AHA Class I post-discharge medications and recommendations in the COURAGE Trial is associated with improved multiple risk factor goal attainment at 5 years of follow-up, and provides compelling, “real-world”evidence that such a model of intensive management can be achieved in patients with established CHD.