Trends in the use of evidence-based treatments for coronary artery disease among women and the elderly: findings from the get with the guidelines quality-improvement program

• Published in: Circulation Cardiovascular quality and outcomes Vol. 2; no. 6; pp. 633 - 641
• Main Authors: Lewis, William R, Ellrodt, A Gray, Peterson, Eric, Hernandez, Adrian F, LaBresh, Kenneth A, Cannon, Christopher P, Pan, Wenqin, Fonarow, Gregg C
• Format: Journal Article
• Language: English
• Published: United States 01.11.2009
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Age Factors; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Aspirin - therapeutic use; Cardiac Catheterization - statistics & numerical data; Coronary Artery Disease - epidemiology; Coronary Artery Disease - therapy; Counseling; Drug Utilization; Evidence-Based Medicine; Female; Guideline Adherence; Humans; Hypolipidemic Agents - therapeutic use; Male; Middle Aged; Myocardial Revascularization - statistics & numerical data; Patient Admission; Patient Discharge; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Program Evaluation; Quality Assurance, Health Care; Sex Factors; Smoking Cessation; United States - epidemiology; United States
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/CIRCOUTCOMES.108.824763

Significant disparities have been reported in the application of evidence-based guidelines in the treatment of coronary artery disease (CAD) in women and the elderly. We hypothesized that participation in a quality-improvement program could improve care for all patients and thus narrow treatment gaps over time. Treatment of 237 225 patients hospitalized with CAD was evaluated in the Get With the Guidelines-CAD program from 2002 to 2007. Six quality measures were evaluated in eligible patients without contraindications: aspirin on admission and discharge, beta-blockers use at discharge, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist use, lipid-lowering medication use, and tobacco cessation counseling along with other care metrics. Over time, composite adherence on these 6 measures increased from 86.5% to 97.4% (+10.9%) in men and 84.8% to 96.2% (+11.4%) in women. There was a slight difference in composite adherence by sex that remained significant over time (P<0.0001), but this was confined to patients <75 years. Composite adherence in younger patients (<75 years) increased from 87.1% to 97.7% (+10.6%) and from 83.0% to 95.1% (+12.1%) in the elderly (>or=75 years) over time. Among hospitals participating in Get With the Guidelines-CAD, guideline adherence has improved substantially over time for both women and men and younger and older CAD patients, with only slight age and sex differences in some measures persisting.