Abstract 17495: Achievement of Secondary Prevention Performance Measures in Patients with Coronary Artery Disease in Teaching and Non-Teaching Hospitals: Results from the Get With The Guidelines CAD Program
Background: Guideline-recommended therapies improve clinical outcomes in patients with non-ST-elevation acute coronary syndrome, and previous studies suggest that academic hospitals are more likely to follow these guidelines.
Methods: To assess the impact of hospital teaching status on performance measures and outcomes in a broad population with CAD, we studied 270,902 patients from 361 hospitals in the GWTG-CAD Program from 1/2000 to 9/2009. The primary outcome was guideline-concordant care, defined as compliance with all six GWTG-CAD quality measures: 1) ASA within 24 hours, 2) ASA at discharge 3) ACEI/ARB for systolic dysfunction, 4) beta blockers at discharge, 5) lipid therapy if LDL >100, 6) smoking cessation. A multivariate model was used to compare the relationship between teaching hospital (TH) non-teaching hospital (NTH) status on quality measures, in-hospital mortality, and length of stay (LOS).
Results: Guideline-concordant care increased from 2000->2009 at TH (65.3% → 88.3%, p<0.001) and NTH (61.0% → 93.9%, p<0.001). The adjusted odds ratio (aOR) for guideline-concordant care at TH compared to NTH was 2.31 (CI 1.33-3.98, p= 0.0027). See figure for aORs of each of the 6 measures. Rates of invasive procedures were similar at TH and NTH. However, TH were more likely to have a LOS ≤ 4 days (aOR 1.37, CI 1.09-1.69) with a trend towards lower in-hospital mortality (aOR 0.81, CI 0.65-1.03).
Conclusions: Care at both TH and NTH participating in the GWTG-CAD program improved over time. In an adjusted analysis, guideline-concordant care was higher in TH, driven mainly by compliance with ASA and beta-blocker guidelines. Treatment at TH was associated with a shorter length of stay and a trend toward lower in-hospital mortality.
- © 2010 by American Heart Association, Inc.