title: Temporal trends for secondary prevention measures among patients hospitalized with coronary artery disease.
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.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas. Electronic address: dharam@post.harvard.edu.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: UCLA Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, Calif.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Emergency Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Division of Cardiology, University of New Mexico, Albuquerque.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.affiliation: Division of Cardiology, University of California, San Francisco.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Maria
authors.initials: M
authors.lastname: Grau-Sepulveda
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D037001:Directive Counseling; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D012042:Registries; D055502:Secondary Prevention / Q000379:methods* / Q000639:trends*; D016540:Smoking Cessation; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D000960:Hypolipidemic Agents; D001241:Aspirin
keywords: Angioplasty; Bypass; Coronary Disease; Registries; Surgery