Adherence to Guideline-Directed Medical Therapy and its association with re-hospitalization and mortality following Coronary Artery Bypass Graft surgery - The 67th Annual Conference of the Israel Heart Society

Liat Orenstein ¹ Yaron Moshkovits ² Keren Laufer ³ Liraz Olmer ⁴ Arnona Ziv ⁵ Rachel Dankner ^1,3,6

¹Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Israel
²Department of Cardiothoracic Surgery, Assuta Tel-Aviv Hospital affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
³Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
⁴Unit for Mathematics and Biostatistics, The Gertner Institute for Epidemiology and Health Policy Research, Israel
⁵Unit for Data Management and Computation, The Gertner Institute for Epidemiology and Health Policy Research, Israel
⁶Patient Oriented Research, The Feinstein Institute for Medical Research, USA

Introduction: We investigated associations with re-hospitalization and long-term mortality, of cardio-thoracic surgeons` adherence to pharmacological guideline-directed medical therapy (GDMT) in discharge recommendations of elective coronary artery bypass graft (CABG) surgery patients.

Material and method: In this longitudinal multicenter study, 1,131 patients who underwent elective CABG surgery in seven medical centers during 2004-2007 were interviewed in the hospital before surgery. Adherence of cardio-thoracic surgeons to GDMT was considered as prescribing medications from three families: antiplatelet therapy, beta-blockers and statins; and was determined from discharge letters. Patients were interviewed one-year after hospitalization to obtain information on re-hospitalizations and current medications. Mortality information was extracted from the Ministry of Internal Affairs registry and updated until March 2018.

Results and discussion: GDMT adherence was evident in the discharge recommendations of 638 patients (56.4%). A propensity score-weighted multivariate logistic regression showed a 26% lower 1-year risk of re-hospitalization\mortality among patients whose discharge recommendations reflected full physician adherence than among patients whose recommendations reflected partial adherence (OR=0.74, 95%CI: 0.57-0.97, p=0.03). Propensity score-weighted Cox proportional hazard (PH) model showed 21% lower long-term mortality hazard among patients with cardio-thoracic surgeons` adherence to GDMT, compared to other patients (HR=0.79, 95% CI: 0.64-0.98, p=0.028). Cox survival analysis also demonstrated a higher survival rate for exposed patients when considering cardio-thoracic surgeons` adherence to statins on their own (HR=0.66, 95% CI: 0.55-0.80, p0.0001>).

Conclusion: The reference in CABG patients’ discharge recommendations to GDMT was associated with a lower 1-y readmissions/mortality and lower long-term mortality. Cardio-thoracic surgeons should adhere closely to preventive medication guidelines.