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Original Articles

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

William R. Lewis, MD; A. Gray Ellrodt, MD; Eric Peterson, MD, MPH; Adrian F. Hernandez, MD; Kenneth A. LaBresh, MD; Christopher P. Cannon, MD; Wenqin Pan, PhD and Gregg C. Fonarow, MD

From the MetroHealth Campus (W.R.L.), Case Western Reserve University, Cleveland, Ohio; Berkshire Medical Center (A.G.E.), Pittsfield, Mass; Duke Clinical Research Institute (E.P., A.F.H., W.P.), Duke University Medical Center, Durham, NC; Research Triangle Institute International (K.A.L.), Waltham, Mass; Cardiovascular Division (C.P.C.), TIMI Study Group, Brigham and Women’s Hospital, Boston, Mass; and the University of California (G.C.F.), Los Angeles, Calif.

Correspondence to William R. Lewis, MD, Chief, Clinical Cardiology, Heart, and Vascular Center, MetroHealth Campus, Case Western Reserve University, 2500 MetroHealth Dr, Hamman 350, Cleveland, OH 44109-1998. E-mail wlewis{at}metrohealth.org

Received October 13, 2008; accepted August 28, 2009.

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.

Key Words: quality control • coronary artery disease • age factors • sex

The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.108.824763/DC1.