Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice
Open accessAbstract
Background—: Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting. Methods and Results—: A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 secondary prevention medications. Conclusions—: Provider-led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.
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A low-intensity quality-improvement programme in a randomized national study of 458 hospitals after bypass surgery significantly increased optimal secondary prevention, with better adherence in all patient subgroups, particularly women and the elderly, and almost eliminated previous treatment gaps.
“A significant increase was observed in the rate of optimal secondary prevention, with better adherence to guidelines in all patient subgroups, particularly women and the elderly; previously existing treatment gaps were almost eliminated, and improvements were seen in the use of lipid-lowering therapy, ACE inhibitor treatment, and tobaccocessation counselling.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [560]
Over 2 years there was a continuous increase in guideline adherence by physicians at patient discharge.
“There appears to be a learning curve: over the course of 2 years there was a continuous increase in guideline adherence by the physicians at discharge of the patients.560”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [560]
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- Authors
- Williams, J. B., DeLong, E. R., Peterson, E. D., Dokholyan, R. S., Ou, F.-S., & Ferguson, T. B.
- Affiliations
- Duke University (US)
- Venue
- Circulation
- Published
- 2011-01
- Volume
- 123
- Issue
- 1
- Pages
- 39-45
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC3683243
- OpenAlex
- W2019040299
- Cited by
- 79
- References
- 30
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 7 · 2014: 4 · 2013: 8 · 2012: 21
- FWCI
- 11.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01hl088953-05, 5t32hl069749-20)
- Agency for Healthcare Research and Quality
- National Heart, Lung, and Blood Institute (T32-HL069749, HL088953, U01-HL088953)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- secondary prevention, coronary artery bypass grafting, continuous quality improvement, medication adherence, aspirin, beta-blockers, ACE inhibitors, lipid-lowering therapy, hospital quality improvement
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Coronary Artery Bypass, Aspirin, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Patient Education as Topic, Registries, Societies, Medical, Time Factors, Treatment Outcome, Secondary Prevention
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