Abstract 17901: A Comparison of Temporal Trends in In-hospital Adherence to Secondary Prevention Measures Among Patients Undergoing Coronary Artery Bypass Graft Surgery, Percutaneous Coronary Intervention or No Intervention: Insights From the GWTG-CAD

Abstract

Objectives: Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing CABG vs. PCI vs. no-intervention for CAD. We sought to study temporal trends in the in-hospital management of patients with CAD in a large national database between 2003 and 2008.

Methods: Using data from the national GWTG-CAD registry, we sought to compare adherence with 6 performance measures (aspirin within 24 hours, discharge on aspirin and beta-blockers, patients with low ejection fraction discharged on angiotensin converting enzyme inhibitor /angiotensin receptor blocker, smoking cessation counseling, use of lipid lowering medications) in eligible CAD patients who underwent CABG, PCI or no-intervention. Temporal trends between the groups were compared using Cochrane-Mantel-Haenszel row means scores statistics.

Results: A total of 113,971 patients with CAD were treated at 193 hospitals between 2003 and 2008 (61% PCI, 13% CABG, 26% no-intervention). Overall adherence with all 6 quality of care measures improved over time in all 3 groups, but remained superior in PCI patients compared with CABG patients at all time points; no-intervention patients fared the worst at all time points (p<0.0001) (Figure). Similarly, 100% adherence to all 6 measures was superior in PCI patients at all time points (p<0.0001).

Conclusions: Significant improvements were noted in adherence to secondary prevention measures in patients hospitalized with CAD over the last decade whether undergoing PCI, CABG, or no-intervention. Yet there still exist select opportunities for improved adherence, particularly in patients undergoing CABG and no-intervention.