Abstract 4735: Is Improved Adherence to Guideline Based Care Among Patients Hospitalized With Acute Myocardial Infarction Restricted to Lower Risk?
Background: The application of ACC/AHA guidelines in managing patients with myocardial infarction (MI) improves subsequent outcomes, especially among those at a higher baseline risk. Prior observations suggest that this group is paradoxically less likely to receive guideline based care (risk-treatment mismatch).
Hypothesis: We sought to examine whether
Guideline based care during hospitalization for an MI varied as a function of patients’ baseline risk;
Temporal improvements in guideline adherence were observed in all risk groups.
Methods: 112,848 MI patients were enrolled at 279 hospitals participating in Get With The Guideline (GWTG-CAD) between August 2000 to December 2008. We developed and validated a risk model (c-statistic 0.75) to stratify patients into tertiles: low (0–3%), intermediate (3–6.5%) and high (>6.5%) in-hospital mortality rates. Use of guideline based care and temporal trends were examined among eligible patients.
Results: High risk patients were older, more females, and had a higher incidence of hypertension, diabetes, hyperlipidemia, prior MI and stroke (p<0.0001 each). Eligible high risk patients were less likely to have their LDL measured, and were less likely to receive statins, ACEi/ARBs, aspirin, β-blockers, diabetic treatment, smoking cessation advice and physical therapy recommendations at discharge compared to those at lower risk (p<0.0001 each). However, this discordance has been decreasing over time (Figure⇓).
Conclusions: While adherence to guideline based care is paradoxically lower in the highest risk patients, care is improving within all risk categories and the gaps between low and high-risk groups appear to be narrowing.
This research has received full or partial funding support from the American Heart Association, National Center.