PS3-26: Reasons for Not Achieving Optimal Secondary Prevention Care for Coronary Artery Disease

Abstract

Background and Aims: Adherence to four secondary prevention goals (not using tobacco, LDL measured and <100 mg/dl within one year, blood pressure <140/90 at last visit, and daily aspirin) significantly improves outcomes for patients with coronary artery disease (ICD 9 410–414). However, a significant proportion of patients fail to achieve these four goals. We wished to determine the reasons why patients with CAD failed to achieve care goals in our multispecialty medical group. Methods: We abstracted 170 randomly-selected records of patients with CAD who failed to achieve care goals. Results: The two most frequent reasons for failure to achieve care goals were: the care team overlooked care needs at the time of an acute care visit (n=98), and the patient failed to return for follow-up (n=28). Other less frequent reasons were: The patient was offered treatment but declined (n=14); the clinician changed a medication in response to a value that was out of range, and the patient was not yet due for follow-up (n=10); and, the patient was not invited back for follow-up (n=9). The following reasons were observed in only one case each: Co-morbid conditions did not justify aggressive goals; the ordering physician failed to follow-up on a completed test; and, the patient was intolerant of statins. Eight patients failed to meet the optimal CAD care goal for other unique reasons. Conclusion: Providing clinical care teams with the tools to better track patient care needs (e.g., electronic patient identification and follow-up systems) could significantly reduce secondary prevention care gaps in our medical group.