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Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice.

Publication ,  Journal Article
Williams, JB; Delong, ER; Peterson, ED; Dokholyan, RS; Ou, F-S; Ferguson, TB; Society of Thoracic Surgeons and the National Cardiac Database,
Published in: Circulation
January 4, 2011

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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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 4, 2011

Volume

123

Issue

1

Start / End Page

39 / 45

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Societies, Medical
  • Secondary Prevention
  • Registries
  • Patient Education as Topic
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

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Williams, J. B., Delong, E. R., Peterson, E. D., Dokholyan, R. S., Ou, F.-S., Ferguson, T. B., & Society of Thoracic Surgeons and the National Cardiac Database, . (2011). Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice. Circulation, 123(1), 39–45. https://doi.org/10.1161/CIRCULATIONAHA.110.981068
Williams, Judson B., Elizabeth R. Delong, Eric D. Peterson, Rachel S. Dokholyan, Fang-Shu Ou, T Bruce Ferguson, and T Bruce Society of Thoracic Surgeons and the National Cardiac Database. “Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice.Circulation 123, no. 1 (January 4, 2011): 39–45. https://doi.org/10.1161/CIRCULATIONAHA.110.981068.
Williams JB, Delong ER, Peterson ED, Dokholyan RS, Ou F-S, Ferguson TB, et al. Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice. Circulation. 2011 Jan 4;123(1):39–45.
Williams, Judson B., et al. “Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice.Circulation, vol. 123, no. 1, Jan. 2011, pp. 39–45. Pubmed, doi:10.1161/CIRCULATIONAHA.110.981068.
Williams JB, Delong ER, Peterson ED, Dokholyan RS, Ou F-S, Ferguson TB, Society of Thoracic Surgeons and the National Cardiac Database. Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice. Circulation. 2011 Jan 4;123(1):39–45.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

January 4, 2011

Volume

123

Issue

1

Start / End Page

39 / 45

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Societies, Medical
  • Secondary Prevention
  • Registries
  • Patient Education as Topic
  • Middle Aged
  • Male
  • Humans
  • Female