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
Lewis, W. R., Ellrodt, A. G., Peterson, E., Hernandez, A. F., LaBresh, K., Cannon, C. P., ... Fonarow, G. C. (2009). 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. Circulation: Cardiovascular Quality and Outcomes, 2(6), 633-641. DOI: 10.1161/CIRCOUTCOMES.108.824763
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, 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 (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.