Background: The American College of Cardiology and The American Heart Association publish specific guidelines for cardiac patients after CABG surgery. These guidelines recommend prescription of anti platelet-aggregants, beta blockers and lipid-lowering medications as a standard therapy for all patients after the surgery.
Objectives: To study the association between adherence to pharmacological guidelines of the discharging cardiac surgeon and prognostic factors of the cardiac patient during first year and 8 years after CABG surgery.
Subjects and Methods: In this prospective study a total of 1132 cardiac patients from 7 medical centers in Israel operated during 2004-2007 were followed since surgery up to 8 years for vital status. Recommended medications were recorded from the letter of discharge. A 1-year follow-up home interview included detailed information on re-hospitalizations and medication use.
Results: Anticoagulants, beta blockers and lipid lowering medications were recommended in 95.5%, 76.6% and in 73.5% of all patients' letter of discharge respectively. One year re-hospitalization rate was 29.6% compared to 46.2% for adherence and non-adherence patients respectively. Multivariate regressions adjusting for propensity score ,summary of SF-36 QoL, years of education and Charlson's co-morbidity index showed that patients who were recommended to receive all three drugs (adherence-patients) had a 22-23% lower risk for re-hospitalization or mortality than non-adherence patients (OR = 0.781, 95%CI: 0.59-1.03, p = 0.076). In addition, Kaplan Meier model showed better survival in adherence-patients (Log Rank P<0.001). Finally, an adjusted Cox's regression model showed that the 8-year mortality risk in adherence-patients was 31.4% lower (HR=0.686, 95%CI: 0.51-0.93, p = 0.015).
Conclusions: Cardiac patients would benefit from adherence of the cardiothoracic physician to medical guidelines in terms of reduced re-hospitalizations and all-cause mortality. Cardiothoracic surgeons should be encouraged to recommend these medications to cardiac patients after CABG surgery in the letter of discharge.
