In-hospital initiation of cardiovascular protective medications for patients undergoing percutaneous coronary intervention: taking advantage of the teachable moment.
Following percutaneous coronary interventions (PCI), patients remain at risk for atherosclerotic vascular disease progression, cardiovascular events and mortality. There is compelling scientific evidence that antiplatelet therapy, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering therapy reduce cardiovascular events, hospitalizations and mortality in patients after PCI. Despite this evidence and national guidelines, a number of studies in a variety of clinical settings have documented that a significant proportion of post-PCI patients are not receiving treatment with these guideline-recommended, evidence-based therapies when guided by conventional care. The demonstration that initiation of cardiovascular protective medications, including lipid-lowering therapy, prior to hospital discharge for cardiovascular events and/or procedures results in a marked increase in treatment rates, improved long-term patient compliance and better clinical outcomes has led to the revision of national guidelines to endorse this approach as the standard of care. Hospital-based cardiovascular performance improvement programs have demonstrated substantial improvements in treatment rates as well as the quality of PCI and other coronary heart disease patient care. Adopting in-hospital initiation of cardiovascular protective medications as the standard of care for patients undergoing PCI could dramatically improve treatment rates and thus substantially reduce the risk of future cardiovascular events, reduce hospitalizations and prolong life in the large number of patients undergoing PCI each year.
Fonarow
Gregg C
GC
UCLA Preventative Cardiology Program, UCLA Division of Cardiology, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D018450:Disease Progression; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D002317:Cardiovascular Agents