Abstract 288: Secondary Prevention Following Coronary Artery Bypass Surgery: The Need For a Continuum of Care

Abstract

Purpose: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. This study assessed the influence of a multidisciplinary educational program on disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following CABG. Methods: Using a prospective, randomized, controlled design, adults undergoing CABG completed surveys at discharge, 3 months, and 12 months, assessing disease understanding and motivation to reduce cardiovascular risk. Four to six weeks after CABG, intervention subjects completed an educational program involving group discussions and individual counseling with pharmacists, dietitians, and a cardiac rehabilitation nurses. The primary endpoint was a composite score of reduced risk factors, medication use among those eligible, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (I=49, C=49). The composite score was not different between groups (I=12.8±4.5 points, C=12.7±4.9 points, p=0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes could not be attributed to our intervention. Medication use declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use is robust at hospital discharge but declines with time and was not improved by our intervention. These findings are concerning and warrant further study.