Optimal Medical Therapy for Known Coronary Artery Disease A Review

IMPORTANCE This review examines the current state-of-the-art optimal medical therapy (OMT) for patients with known coronary artery disease. This therapy, which is sometimes labeled as secondary prevention, is effective in preventing recurrent events and is recommended by the American College of Cardiology Foundation/American Heart Association guidelines. Optimal medical therapy is of recognized public health benefit. OBSERVATIONS The available evidence from broad patient populations, contemporary randomized trials, and multiple recent studies with pharmacy records indicates that the delivery of OMT is far from ideal. We suggest approaches for quality improvement, including better patient education, the increased use of interventions that are known to improve compliance, and the use of performance measures focused on long-term OMT in outpatient care. CONCLUSIONS AND RELEVANCE Improvement in the delivery of OMT to patients with coronary artery disease is one possible step to help the United States reduce the recently reported increase in death rate from heart disease.