title: Quality of medical management in coronary artery disease.
abstract: OBJECTIVE
  Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure < 140/90 mm Hg ( < 130/80 mm Hg in diabetics and renal disease patients), low-density lipoprotein (LDL) < 2 mmol/L, smoking cessation and aerobic physical activity, and hemoglobin (Hb) A1c < 7%. Unfortunately, preliminary data suggest a wide gap between recommended and actual practices. The study aims to estimate the rate of achieving of OMT in CAD patients in Qassim Province.
  
  
  METHODS
  This observational study enrolled 207 consecutive CAD patients seen in cardiology clinic in Prince Sultan Cardiac Center in Qassim between January 2012 and May 2012.
  
  
  METHODS
  Eligible participants were over the age of 18, with CAD documented by either noninvasive testing or by coronary angiogram. We collected the demographic, medications, laboratory, and clinical data through in-person interviews, medical records, and an electronic patient database.
  
  
  RESULTS
  OMT was achieved in only 10.4% of CAD patients. The rate of achievement of target systolic blood pressure was 76.5%, target diastolic blood pressure 88%, target LDL 68%, adherence to medications 91%. Diabetes was common (64% of all patients), and only 24% of these patients achieved the target HbA1c.
  
  
  CONCLUSIONS
  The poor achievement of optimal medical therapy in CAD patients contributes to prevent.able mortality, morbidity, and health care costs. The observed shortcomings warrant investment in strategies to achieve OMT in these high-risk patients.
authors.affiliation: Owayed Al-Shammeri, MD, Department of Medicine, Qassim University,, PO Box 6655, Buraidah 51452, Saudi Arabia, T: +966 53 272 1010,, F: +966 11 490 4444, owayed.alshammeri@qumed.edu.sa.
authors.forename: Owayed
authors.initials: O
authors.lastname: Al Shammeri
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
authors.forename: Ahlam
authors.initials: A
authors.lastname: Alzenaidi
authors.forename: Bushra
authors.initials: B
authors.lastname: Al-Hutaly
authors.forename: Alaa
authors.initials: A
authors.lastname: Abdulmonem
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy*; D050171:Dyslipidemias / Q000150:complications / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006442:Glycated Hemoglobin; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D040242:Risk Reduction Behavior; D012529:Saudi Arabia; D016540:Smoking Cessation
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D010975:Platelet Aggregation Inhibitors; C517652:hemoglobin A1c protein, human