Temporal Trends for Secondary Prevention Measures Among Patients Hospitalized with Coronary Artery Disease - 20/03/15
, Gregg C. Fonarow, MD b, Christopher P. Cannon, MD c, Adrian F. Hernandez, MD d, Eric D. Peterson, MD, MPH d, W. Frank Peacock, MD e, Warren K. Laskey, MD f, Prakash Deedwania, MD g, Maria Grau-Sepulveda, MD d, Lee H. Schwamm, MD h, Deepak L. Bhatt, MD, MPH cfor the
Get With the Guidelines Steering Committee and Investigators
Abstract |
Background |
Prior studies have noted that in-hospital adherence to secondary prevention measures varied among patients undergoing coronary artery bypass graft surgery, percutaneous coronary revascularization, or no intervention. We sought to study contemporary temporal trends in the in-hospital management of patients with coronary artery disease.
Methods |
By using data from the Get With The Guidelines-Coronary Artery Disease registry, we compared adherence to 6 performance measures (aspirin within 24 hours, discharge on aspirin, discharge on beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, and use of lipid-lowering medications) in eligible patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or no intervention between 2003 and 2008.
Results |
A total of 113,971 patients with coronary artery disease were treated at 193 hospitals. Overall adherence to all 6 quality of care measures improved over time in all 3 treatment groups, but was highest at all time periods in the percutaneous coronary intervention group compared with the coronary artery bypass graft surgery group, whereas the no intervention group had the lowest use of prevention measures at all time points (P < .0001). Likewise, 100% adherence to all 6 measures was superior in the percutaneous coronary intervention group at all time points (P < .0001). On multivariable adjustment for case-mix of patients, the majority of these differences persisted.
Conclusions |
Over the last decade, overall adherence with secondary prevention measures improved significantly in patients hospitalized with coronary artery disease regardless of revascularization strategy. However, there still exist select opportunities for improving adherence, particularly among patients undergoing coronary artery bypass graft surgery or no intervention.
Le texte complet de cet article est disponible en PDF.Keywords : Angioplasty, Bypass, Coronary Disease, Registries, Surgery
Plan
| Funding: Get With The Guidelines-Coronary Artery Disease is a program of the American Heart Association and is supported by an unrestricted educational grant from Merck/Schering-Plough Pharmaceutical. Data collection and management were performed by Outcome, Inc (Cambridge, Mass). The analysis of registry data was performed at Duke Clinical Research Institute (Durham, NC), which also receives funding from the American Heart Association. The sponsor was not involved in the management, analysis, or interpretation of data or the preparation of the manuscript. |
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| Conflict of Interest: DJK: Honoraria from the American College of Cardiology. GCF: Consultant for Novartis (significant), Johnson & Johnson (modest), and Bayer (modest). AFH: Research Grants from Johnson & Johnson. EDP: Research Grants from BMS Sanofi, Merck, Eli Lilly, and Ortho McNeil Pharmaceutical. WFP: Research Grants (significant) from Abbott, Alere, Brahms, and The Medicines Company; Consultant (modest) for Abbott, Alere, Beckman Coulter, and The Medicines Company; ownership interest (modest) in Comprehensive Research Associates LLC, Vital Sensors, and Emergencies in Medicine LLC. DLB: Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Associate Editor; Section Editor, Pharmacology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor); Research Funding: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 128 - N° 4
P. 426.e1-426.e9 - avril 2015 Retour au numéro
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