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Improving Compliance with CAD Secondary Prevention



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Am Fam Physician. 2004 Nov 15;70(10):1980-1981.

Coronary artery disease (CAD) is a leading cause of mortality in the United States, despite advances in understanding the underlying risk factors and drug therapy options, and the development of practice guidelines for secondary prevention. Many patients fail to meet their clinical treatment goals because of poor physician adherence to guidelines, poor patient compliance, and comorbidities that require modifications to management plans. One area in which this lack is evident is in the management of hyperlipidemia. Despite well-established guidelines, implementation of the guidelines lags in clinical practice. In response to these issues, the American Heart Association developed the Get with the Guidelines (GWTG) program, which is an acute-care, hospital-based, quality-improvement program. Its goal is to improve the use of pharmacotherapy such as aspirin, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and beta blockers, as well as lifestyle modifications, including smoking cessation, weight loss, physical activity, and diabetes control. LaBresh and associates evaluated the effect of the GWTG program using Web-based technology and a collaborative model on secondary prevention in patients with CAD.

The trial was a multicenter, hospital-based effort to implement a secondary prevention strategy for CAD. Workshops were held regularly to review clinical guidelines, discuss best practice examples, and identify barriers to implemention of the program. The teams developed a point-of-service, interactive, Web-based patient-management tool to collect data and provide real-time feedback and analysis of their performance. Data were collected from patients admitted over a one-year period to the participating hospitals with the diagnosis of acute myocardial infarction, unstable angina, coronary revascularization, and congestive heart failure. Outcome measurements included the differences between baseline data and data collected 10 to 12 months after implemention of the program. Included in the data collection was information about the use of aspirin, beta blockers, and ACE inhibitors. In addition, information was gathered about cholesterol measurements and treatment, smoking-cessation counseling, blood pressure control, and cardiac rehabilitation referral.

Data were available for a total of 1,738 patients involved in the study. From baseline to the 10- to 12-month follow-up, the percentage of patients who received smoking-cessation counseling increased significantly, from 48 to 87 percent. In addition, patients at the end of the study were significantly more likely to receive lipid measurements and treatment, and referral for cardiac rehabilitation. Blood pressure control showed an improvement trend that did not reach statistical significance. Men had a significant improvement in smoking-cessation counseling, lipid treatment, low-density lipoprotein measurements, blood pressure control, and cardiac rehabilitation referral. The only increases noted in women were in lipid treatment and cardiac rehabilitation referral. Patients 65 years and older had increases in all measurements except for aspirin, beta blocker, and ACE inhibitor use.

The authors conclude that the GWTG program improves adherence to preventive guidelines in hospitalized patients with CAD.

LaBresh KA, et al. Get with the guidelines for cardiovascular secondary prevention. Pilot results. Arch Intern Med. January 26, 2004;164:203–9.


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