Abstract 12098: Influence of Recent Hospitalization for Non-coronary Events on the Use of Preventive Medications for Coronary Artery Disease
Background: Increasingly, comprehensive patient care is the goal of high-quality systems instead of diagnosis or procedure driven care. The current emphasis on secondary prevention of coronary artery disease (CAD) on discharge after acute coronary syndrome (ACS) may fail to improve the preventive care of patients after non-ACS hospitalizations.
Methods: We estimated the effect of a recent non-ACS hospitalization on the prescription of secondary preventive medications compared with the effect of recent ACS hospitalization among patients with a history of CAD treated at Veterans Affairs (VA) medical centers between January 1, 2005 and November 22, 2006. We used logistic regression to produce adjusted proportions.
Results: In 13,211 CAD patients, 58% were on aspirin, 70% on β-blocker, 60% on angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), 65% on lipid-lowering therapy, and 25% on all four medications prior to the index event. Non-ACS hospitalization in the 6 months prior to the index event did not substantially affect the adjusted proportion on preventive medications (Figure 1A). In contrast, among patients hospitalized for ACS in the prior 6 months, the adjusted proportion prescribed aspirin was 21% higher (p<0.001), β-blocker was 14% higher (p<0.001), ACE-I or ARB was 9% higher (p<0.001), lipid therapy was 12% higher (p<0.001), and prescribed all four medications was 18% higher (p<0.001) compared with patients hospitalized for ACS more than 2 years ago (Figure 1B).
Conclusions: Recent non-ACS hospitalization did not influence preventive medication use in patients with known CAD and represents a missed opportunity to improve patient care. The same protocols which drive the robust influence of a recent ACS hospitalization on preventive medication use might be transferred to any discharge in a system striving to provide comprehensive care.
- © 2010 by American Heart Association, Inc.