title: Recent Trends in Adherence to Secondary Prevention Guidelines for Patients Undergoing Coronary Revascularization in Washington State: An Analysis of the Clinical Outcomes Assessment Program (COAP) Registry.
abstract: BACKGROUND
  Previous studies indicated that patients undergoing coronary artery bypass graft (CABG) surgery are less likely to receive guideline-based secondary prevention therapy than are those undergoing percutaneous coronary intervention (PCI) after an acute myocardial infarction. We aimed to evaluate whether these differences have persisted after the implementation of public reporting of hospital metrics.
  
  
  RESULTS
  The Clinical Outcomes Assessment Program (COAP) database was analyzed retrospectively to evaluate adherence to secondary prevention guidelines at discharge in patients who underwent coronary revascularization after an acute ST-elevation myocardial infarction in Washington State. From 2004 to 2007, 9260 patients received PCI and 692 underwent CABG for this indication. Measures evaluated included prescription of aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, or lipid-lowering medications; cardiac rehabilitation referral; and smoking-cessation counseling. Composite adherence was lower for CABG than for PCI patients during the period studied (79.6% versus 89.7%, P<0.01). Compared to patients who underwent CABG, patients who underwent PCI were more likely to receive each of the pharmacological therapies. There was no statistical difference in smoking-cessation counseling (91.7% versus 90.3%, P=0.63), and CABG patients were more likely to receive referral for cardiac rehabilitation (70.9% versus 48.3%, P<0.01). Adherence rates improved over time among both groups, with no significant difference in composite adherence in 2006 (85.6% versus 87.6%, P=0.36).
  
  
  CONCLUSIONS
  Rates of guideline-based secondary prevention adherence in patients with ST-elevation myocardial infarction who underwent CABG surgery have been improving steadily in Washington State. The improvement possibly is associated with the implementation of public reporting of quality measures.
authors.affiliation: Section on Cardiology, Wake Forest University Health SciencesWinston-Salem,  USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Riley
authors.affiliation: Section on Cardiology, Wake Forest University Health SciencesWinston-Salem, NC (R.F.R.) Division of Cardiology, University of Washington, Seattle, WA (C.W.D., J.P.).
authors.forename: Creighton W
authors.initials: CW
authors.lastname: Don
authors.affiliation: Cardiothoracic Surgery, University of Washington, Seattle, WA (G.S.A., N.A.M.).
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Aldea
authors.affiliation: Cardiothoracic Surgery, University of Washington, Seattle, WA (G.S.A., N.A.M.).
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.affiliation: Division of Cardiology, University of Washington, Seattle, WA (C.W.D., J.P.).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Probstfield
authors.affiliation: School of Public Health, University of Washington, Seattle, WA (C.M.).
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.affiliation: Division of General Internal Medicine, Harborview Medical Center, Seattle, WA (J.R.G.).
authors.forename: J Richard
authors.initials: JR
authors.lastname: Goss
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention / Q000534:rehabilitation*; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000592:standards*; D014861:Washington
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D001241:Aspirin
keywords: angioplasty; coronary artery bypass; guideline adherence; myocardial infarction; prevention; registries; secondary prevention