Hiratzka Loren F, Eagle Kim A, Liang Li, Fonarow Gregg C, LaBresh Kenneth A, Peterson Eric D
Cardiac Vascular and Thoracic Surgeons, Inc., Cincinnati, Ohio, USA.
Circulation. 2007 Sep 11;116(11 Suppl):I207-12. doi: 10.1161/CIRCULATIONAHA.106.681247.
The American Heart Association Get With the Guidelines-Coronary Artery Disease program facilitates patient and physician compliance with proven atherosclerosis risk reduction strategies with collaborative learning sessions, teaching materials, predischarge online check lists, and web-based performance measure feedback for continuous quality improvement. Patients having coronary artery bypass graft surgery (CABG) may be subject to different care processes, nursing unit pathways, and personnel than patients having percutaneous catheter intervention or neither intervention, which may affect compliance.
The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with secondary prevention performance measures for CABG patients was different from that for nonsurgical patients. A total of 119,106 patients were treated with CABG (14,118), percutaneous catheter intervention (58,702), or neither intervention (46,286). Compliance with medication prescriptions, including aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering drugs, and smoking cessation counseling for eligible patients was analyzed. Medically appropriate exclusions and contraindications were included in the analysis. After adjusting for 14 clinical variables, CABG patients were less likely to receive most secondary prevention measures relative to percutaneous catheter intervention patients. In contrast, CABG patients were more likely to receive aspirin, beta-blocker, and smoking cessation counseling than neither intervention patients. Composite adherence and defect-free rates were highest for percutaneous catheter intervention patients and lowest for neither intervention patients after adjustment.
There are significant differences in compliance at hospital discharge with secondary prevention performance measures for CABG patients compared with nonsurgical patients. Process of care differences may explain these differences and should be examined further because significant opportunities for improved compliance are evident. CABG patients in particular represent a group for whom secondary prevention has proven benefits, and they may benefit from future quality improvement interventions.
美国心脏协会的“遵循指南 - 冠状动脉疾病”项目通过协作学习课程、教学材料、出院前在线检查表以及基于网络的绩效评估反馈来促进患者和医生遵守已证实的动脉粥样硬化风险降低策略，以持续提高质量。与接受经皮导管介入治疗或未接受任何干预的患者相比，接受冠状动脉旁路移植术（CABG）的患者可能会经历不同的护理流程、护理单元路径和人员配置，这可能会影响依从性。
查询“遵循指南 - 冠状动脉疾病”数据库，以确定CABG患者对二级预防绩效指标的依从性是否与非手术患者不同。共有119,106例患者接受了CABG治疗（14,118例）、经皮导管介入治疗（58,702例）或未接受任何干预（46,286例）。分析了对符合条件的患者的药物处方依从性，包括阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和降脂药物，以及戒烟咨询情况。分析中纳入了医学上适当的排除和禁忌情况。在对14个临床变量进行调整后，相对于经皮导管介入治疗患者，CABG患者接受大多数二级预防措施的可能性较小。相比之下，与未接受任何干预的患者相比，CABG患者更有可能接受阿司匹林、β受体阻滞剂和戒烟咨询。调整后，经皮导管介入治疗患者的综合依从率和无缺陷率最高，未接受任何干预的患者最低。
与非手术患者相比，CABG患者出院时对二级预防绩效指标的依从性存在显著差异。护理流程差异可能解释了这些差异，应进一步研究，因为明显存在改善依从性的重大机会。特别是CABG患者是已证实二级预防有益的群体，他们可能会从未来的质量改进干预措施中受益。
