title: Recent hospitalization for non-coronary events and use of preventive medications for coronary artery disease: an observational cohort study.
abstract: BACKGROUND
  High-quality systems have adopted a comprehensive approach to preventive care instead of diagnosis or procedure driven care. The current emphasis on prescribing medications to prevent complications of coronary artery disease (CAD) at discharge following an acute coronary syndrome (ACS) may exclude high-risk patients who are hospitalized with conditions other than ACS.
  
  
  METHODS
  Among a sample of patients with CAD treated at Veterans Affairs medical centers between January, 2005 and November, 2006, we investigated whether recent non-ACS hospitalization was associated with prescriptions of preventive medications as compared with patients recently hospitalized with ACS.
  
  
  RESULTS
  Of 13,211 patients with CAD, 58% received aspirin, 70% β-blocker, 60% angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), and 65% lipid-lowering therapy. Twenty-five percent of eligible patients were receiving all four medications. Having been hospitalized for a non-ACS event in the prior 6 months did not substantially affect the adjusted proportion on preventive medications. 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) than among patients hospitalized for ACS more than 2 years earlier.
  
  
  CONCLUSIONS
  Being hospitalized for a non-ACS condition did not appear to influence preventive medication use among patients with CAD and represents a missed opportunity to improve patient care. The same protocols employed to improve use of preventive medications in patients discharged for ACS might be extended to CAD patients discharged for other conditions as well.
authors: Health Services Research & Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, WA, USA. Steve.Bradley@va.gov
authors: Steven M
authors: SM
authors: Bradley
authors: Chris L
authors: CL
authors: Bryson
authors: Charles
authors: C
authors: Maynard
authors: Thomas M
authors: TM
authors: Maddox
authors: Stephan D
authors: SD
authors: Fihn
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D014728:Veterans
chemical_list: D002317:Cardiovascular Agents