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Ann Thorac Surg 2003;75:758-760
© 2003 The Society of Thoracic Surgeons

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Editorial

Secondary prevention after coronary bypass: the American Heart Association "Get with the Guidelines" program

^a Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
^b Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
^c Division of Cardiology, University of California Los Angeles School of Medicine, Los Angeles, California, USA
^d Mass Pro, Providence, Rhode Island, USA

^* Address reprint requests to Dr Denton, Heart Institute of the High Desert, 12332 Hesperia Rd, Victorville, CA 92332, USA.
e-mail: tim@thedentons.us

The first 20% of the full text of this article appears below.

Invasive coronary procedures such as coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) have changed the face of cardiac care, providing significant improvements in survival and quality of life for patients with coronary artery disease (CAD). In 1999 there were almost 1 million invasive procedures performed in the United States [1] and their clinical benefit has been demonstrated in a multitude of investigations. The importance of these procedures is clear but they do not exist in isolation—their foundation lies in the medical therapy that should be optimized in all patients with CAD.

Although the importance of optimal medical therapy is self-evident, a large body of literature demonstrates its underutilization in patients with vascular disease [2–5]. This treatment gap indicates we are not providing medical therapy for patients who need it most. In this review we discuss medical therapies known to alter the atherosclerotic process based on the secondary prevention guidelines of the American Heart Association (AHA) and the American College of Cardiology (ACC). We also introduce a nationwide program from the AHA called "Get with the Guidelines," the goal of which is to assure that all patients with known vascular disease are discharged from the hospital with the secondary prevention guidelines addressed.

Secondary prevention guidelines

The AHA and ACC have published detailed secondary prevention guidelines for medical therapy in patients with vascular disease (Table 1) that include specific drug recommendations (antithrombotics, beta blockers, angiotension-converting enzyme [ACE] inhibitors, and lipid agents), disease management (diabetes, hypertension), and lifestyle changes (exercise, smoking cessation, weight management). The most recent guideline iteration addresses new data and recommendations from other national organizations [6]. Changes from previous guidelines include (1) considering ACE inhibitors for all . . . [Full Text of this Article]

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