title: Evaluation of preventive cardiovascular pharmacotherapy after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of patients who underwent coronary artery bypass graft (CABG) surgery—including specific drugs and their dosages, drug adherence, and assessment of targeted therapy--from admission to 1 year after CABG surgery.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Cardiovascular quaternary care medical center in Edmonton, Canada.
  
  
  METHODS
  The entire cohort consisted of 1031 adults who underwent CABG surgery between January 2009 and March 2010; a randomly selected subset of 151 patients was used to evaluate medication use and target-directed therapy at 1 year after CABG surgery.
  
  
  RESULTS
  Utilization rates of aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEIs/ARBs) on admission and at discharge were determined for the entire cohort by using data from a large clinical patient registry. The proportion of patients discharged receiving all four classes of medications was 35%. Individual utilization rates for aspirin, β-blockers, and statins were 96%, 94%, and 95%, respectively; use of ACEIs/ARBs was lowest at 42%. In the 1-year post-CABG surgery substudy, medication use and target-directed therapy at 1 year after CABG surgery were evaluated by using community pharmacy and electronic health records. The proportion of patients receiving all four classes of medications at 1 year was 48%. Individual utilization rates for aspirin, β-blockers, statins, and ACEIs/ARBs were 95%, 84%, 84%, and 65%, respectively. Medication adherence, assessed by the medication possession ratio, for β-blockers, statins, and angiotensin-modulating agents at 1 year exceeded 0.85, thereby demonstrating high adherence. Evaluation of target-directed treatment of dyslipidemia and diabetes mellitus demonstrated suboptimal control, with only 66% and 54% of patients, respectively, achieving the recommended therapeutic targets.
  
  
  CONCLUSIONS
  The utilization rate for patients receiving all four classes of secondary prevention cardiovascular medications was 35% at discharge and 48% at 1 year after CABG surgery. These rates were primarily limited by the low utilization of angiotensin-modulating agents, although their rate improved by 22% from discharge. Utilization rates, however, were high for aspirin, β-blockers, and statins both at discharge and 1 year after surgery. Opportunities remain to further optimize secondary prevention cardiovascular pharmacotherapy in patients who undergo CABG surgery, either while in the hospital or immediately subsequent to discharge.
authors.forename: Arden R
authors.initials: AR
authors.lastname: Barry
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Koshman
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Pearson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002170:Canada; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin