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

Background—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. Methods and Results—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, β-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 (≥75 years) over time. Conclusions—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.

[1]  W. Kostis,et al.  Trends in Mortality of Acute Myocardial Infarction After Discharge From the Hospital , 2010, Circulation. Cardiovascular quality and outcomes.

[2]  Joshua T. Cohen,et al.  Comparative Effectiveness of ST-Segment–Elevation Myocardial Infarction Regionalization Strategies , 2010, Circulation. Cardiovascular quality and outcomes.

[3]  Harlan M Krumholz,et al.  National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure: Update on Publicly Reported Outcomes Measures Based on the 2010 Release , 2010, Circulation. Cardiovascular quality and outcomes.

[4]  Dong Zhao,et al.  Future Cardiovascular Disease in China: Markov Model and Risk Factor Scenario Projections From the Coronary Heart Disease Policy Model–China , 2010, Circulation. Cardiovascular quality and outcomes.

[5]  Nikki M. Carroll,et al.  Delays in Filling Clopidogrel Prescription After Hospital Discharge and Adverse Outcomes After Drug-Eluting Stent Implantation: Implications for Transitions of Care , 2010, Circulation. Cardiovascular quality and outcomes.

[6]  Jennifer G. Robinson,et al.  Evaluation of the American Heart Association Cardiovascular Disease Prevention Guideline for Women , 2010, Circulation. Cardiovascular quality and outcomes.

[7]  L. Newby,et al.  Twelve-Year Follow-Up of American Women's Awareness of Cardiovascular Disease Risk and Barriers to Heart Health , 2010, Circulation. Cardiovascular quality and outcomes.

[8]  Eric E. Smith,et al.  Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke , 2010, Circulation. Cardiovascular quality and outcomes.

[9]  E. Fisher,et al.  Regional Variation in Carotid Artery Stenting and Endarterectomy in the Medicare Population , 2010, Circulation. Cardiovascular quality and outcomes.

[10]  Li Liang,et al.  A Validated Risk Score for In-Hospital Mortality in Patients With Heart Failure From the American Heart Association Get With the Guidelines Program , 2010, Circulation. Cardiovascular quality and outcomes.

[11]  K. Schulman,et al.  Costs of Inpatient Care Among Medicare Beneficiaries With Heart Failure, 2001 to 2004 , 2010, Circulation. Cardiovascular quality and outcomes.

[12]  Steven M. Paul,et al.  A Randomized Clinical Trial to Reduce Patient Prehospital Delay to Treatment in Acute Coronary Syndrome , 2009, Circulation. Cardiovascular quality and outcomes.

[13]  B. Lindahl,et al.  Improved Clinical Outcome After Acute Myocardial Infarction in Hospitals Participating in a Swedish Quality Improvement Initiative , 2009, Circulation. Cardiovascular quality and outcomes.

[14]  S. Normand,et al.  Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission , 2009, Circulation. Cardiovascular quality and outcomes.

[15]  Arthur L Kellermann,et al.  A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols , 2009, Circulation. Cardiovascular quality and outcomes.

[16]  D. Berman,et al.  Quantitative Results of Baseline Angiography and Percutaneous Coronary Intervention in the COURAGE Trial , 2009, Circulation. Cardiovascular quality and outcomes.

[17]  JacquesTurgeon,et al.  The Impact of a Multidisciplinary Information Technology–Supported Program on Blood Pressure Control in Primary Care , 2009 .

[18]  Jacques LeLorier,et al.  The Impact of a Multidisciplinary Information Technology–Supported Program on Blood Pressure Control in Primary Care , 2009, Circulation. Cardiovascular quality and outcomes.

[19]  J. Russo,et al.  Understanding Why Patients Delay Seeking Care for Acute Coronary Syndromes , 2009, Circulation. Cardiovascular quality and outcomes.

[20]  K. Murray,et al.  Cardiovascular Risks of Nonsteroidal Antiinflammatory Drugs in Patients After Hospitalization for Serious Coronary Heart Disease , 2009, Circulation. Cardiovascular quality and outcomes.

[21]  R. Collins,et al.  Statin Cost-Effectiveness in the United States for People at Different Vascular Risk Levels , 2009, Circulation. Cardiovascular quality and outcomes.

[22]  E. Granger,et al.  Use of Oseltamivir After Influenza Infection Is Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes Among Military Health System Beneficiaries With Prior Cardiovascular Diseases , 2009, Circulation. Cardiovascular Quality and Outcomes.

[23]  Thomas E. Moritz,et al.  Perioperative Complications After Vascular Surgery Are Predicted by the Revised Cardiac Risk Index But Are Not Reduced in High-Risk Subsets With Preoperative Revascularization , 2009, Circulation. Cardiovascular quality and outcomes.

[24]  M. Desai,et al.  From Here to JUPITER: Identifying New Patients for Statin Therapy Using Data From the 1999–2004 National Health and Nutrition Examination Survey , 2009, Circulation. Cardiovascular quality and outcomes.

[25]  C. Cannon,et al.  An organized approach to improvement in guideline adherence for acute myocardial infarction: results with the Get With The Guidelines quality improvement program. , 2008, Archives of internal medicine.

[26]  Christopher E. Buller,et al.  2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines , 2008, Circulation.

[27]  Christopher E. Buller,et al.  2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2008, Journal of the American College of Cardiology.

[28]  Sidney C. Smith,et al.  Improved treatment of hospitalized coronary artery disease patients with the get with the guidelines program. , 2007, Critical pathways in cardiology.

[29]  Prakash Deedwania,et al.  Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease: Results of the Study Assessing Goals in the Elderly (SAGE) , 2007, Circulation.

[30]  K. Eagle,et al.  Sex differences in the application of evidence-based therapies for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice projects in Michigan. , 2006, Archives of internal medicine.

[31]  M. Pfeffer,et al.  AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. , 2006, Journal of the American College of Cardiology.

[32]  M. Pfeffer,et al.  AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. , 2006, Circulation.

[33]  Donald M Berwick,et al.  All-or-none measurement raises the bar on performance. , 2006, JAMA.

[34]  K. Alexander,et al.  Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. , 2005, Journal of the American College of Cardiology.

[35]  Robert Parrish,et al.  Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan. , 2005, Journal of the American College of Cardiology.

[36]  L. Newby,et al.  Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/Ameri , 2005, Journal of the American College of Cardiology.

[37]  A. Laupacis,et al.  Effect of age on the use of evidence-based therapies for acute myocardial infarction. , 2004, American heart journal.

[38]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[39]  B. Cheung,et al.  Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes. , 2004, British journal of clinical pharmacology.

[40]  R. Gliklich,et al.  Using "get with the guidelines" to improve cardiovascular secondary prevention. , 2003, Joint Commission journal on quality and safety.

[41]  E. McGlynn,et al.  The quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[42]  H. Krumholz,et al.  Effects of age on the quality of care provided to older patients with acute myocardial infarction. , 2003, The American journal of medicine.

[43]  J. Gore,et al.  A community-wide survey of physician practices and attitudes toward cholesterol management in patients with recent acute myocardial infarction. , 2002, Archives of Internal Medicine.

[44]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[45]  K. Alexander,et al.  Representation of elderly persons and women in published randomized trials of acute coronary syndromes. , 2001, JAMA.

[46]  C. Furberg,et al.  Sex bias and underutilization of lipid-lowering therapy in patients with coronary artery disease at academic medical centers in the United States and Canada. Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) Investigators. , 2000, Archives of internal medicine.

[47]  K. Labresh,et al.  Get with the guidelines. , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[48]  L. Kohn,et al.  COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA , 2000 .

[49]  F. Mosteller,et al.  A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. , 1992, JAMA.

[50]  E. Sonnenblick,et al.  Metoprolol-induced reduction in postinfarction mortality: pooled results from five double-blind randomized trials. , 1992, European heart journal.