Quality of medical management in coronary artery disease

BACKGROUND AND OBJECTIVES: Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angiotensin-converting enzyme inhibitors, blood pressure <140/90 mm Hg (<130/80 mm Hg in diabetics and renal disease patients), low-density lipoprotein (LDL) <2 mmol/L, smoking cessation and aerobic physical activity, and hemoglobin (Hb) A1c <7%. Unfortunately, preliminary data suggest a wide gap between recommended and actual practices. The study aims to estimate the rate of achieving of OMT in CAD patients in Qassim Province. DESIGN AND SETTINGS: This observational study enrolled 207 consecutive CAD patients seen in cardiology clinic in Prince Sultan Cardiac Center in Qassim between January 2012 and May 2012. METHODS: Eligible participants were over the age of 18, with CAD documented by either noninvasive testing or by coronary angiogram. We collected the demographic, medications, laboratory, and clinical data through in-person interviews, medical records, and an electronic patient database. RESULTS: OMT was achieved in only 10.4% of CAD patients. The rate of achievement of target systolic blood pressure was 76.5%, target diastolic blood pressure 88%, target LDL 68%, adherence to medications 91%. Diabetes was common (64% of all patients), and only 24% of these patients achieved the target HbA1c. CONCLUSION: The poor achievement of optimal medical therapy in CAD patients contributes to preventable mortality, morbidity, and health care costs. The observed shortcomings warrant investment in strategies to achieve OMT in these high-risk patients.