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Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from the Get With The Guidelines-Coronary Artery Disease program.

Abstract：

BACKGROUND:Secondary prevention therapies improve longitudinal outcomes in patients with coronary artery disease. Previous studies showed that teaching hospitals (THs) more consistently use evidence-based secondary prevention therapies than non-THs (NTHs). It is unclear whether these differences persist after initiation of a national quality improvement system. METHODS AND RESULTS:We analyzed 270902 patients across 361 hospitals in the Get With The Guidelines-Coronary Artery Disease program from June 2000 to September 2009. The primary outcome was guideline-concordant care, defined as compliance with all Get With The Guidelines-Coronary Artery Disease quality measures: (1) aspirin within 24 hours, (2) aspirin at discharge, (3) angiotensin-converting enzyme inhibitor/angiotensin receptor blockers for systolic dysfunction, (4) β-blockers at discharge, (5) lipid therapy if low-density lipoprotein >100 mg/dL, and (6) smoking cessation. We used multivariate modeling to compare the relationship between TH and NTH status on quality measures, in-hospital mortality, and length of stay. Guideline-concordant care was higher at THs (78.4% versus 73.3%; P<0.01). The adjusted odds ratio between 2000 and 2009 for guideline-concordant care at THs compared with NTHs was 2.78 (confidence interval, 1.28-6.06; P=0.01). Guideline-concordant care increased from 2000 to 2009 at THs (n=176; 65.3%→88.3%; adjusted odds ratio for year increase, 1.24 [confidence interval, 1.16-1.30; P<0.01]) and NTHs (n=185; 61.0%→93.9%; adjusted odds ratio for year increase, 1.35 [confidence interval, 1.26-1.45]; P<0.01). THs had shorter length of stay (adjusted odds ratio, 0.74 for length of stay >4 days; confidence interval, 0.58-0.94) from 2000 to 2009. Lower in-hospital mortality was observed at THs (3.7% versus 4.4% at NTHs; P<0.01), but this was not significant after adjustment. CONCLUSIONS:Adherence to guideline-recommended therapies increased over time with participation in the Get With The Guidelines-Coronary Artery Disease program, regardless of the teaching status. Guideline-concordant care over the full decade was higher in THs; however, NTHs demonstrated greater incremental improvement over time.

journal_name

Circ Cardiovasc Qual Outcomes

journal_title

Circulation. Cardiovascular quality and outcomes

authors

Tam LM,Fonarow GC,Bhatt DL,Grau-Sepulveda MV,Hernandez AF,Peterson ED,Schwamm LH,Giugliano RP,GWTG Steering Committee and Investigators.

doi

10.1161/CIRCOUTCOMES.112.965525

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

58-65

issue

eissn

1941-7713

issn

1941-7705

pii

CIRCOUTCOMES.112.965525

journal_volume

pub_type

杂志文章,多中心研究

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Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from the Get With The Guidelines-Coronary Artery Disease program.