A JAMA article using NCDR data came out this week that looked at whether the findings of the COURAGE trial are being implemented clinically. As you recall, COURAGE suggested that providing optimal medical therapy (OMT) to all patients should be attempted before performing PCI (angioplasty and stents) for patients with stable coronary artery disease (CAD), and that many recipients of angioplasty and stents would have benefitted just as well on OMT alone, and without the PCI procedures (of course, that also implies the patients are actually taking their meds, and we know 50% of the time, even when appropriately prescribed, they are NOT).

The study cohort was comprised of 467,211 patients, of whom 37.1% underwent PCI before and 293,795 (62.9%) underwent PCI after publication of the COURAGE trial. Before COURAGE, OMT was used in 44% of patients before PCI, and 65% of patients received it at discharge. There was only a slight change in use of OMT prior to PCI after the COURAGE trial (43.5% prior to COURAGE and 44.7% after COURAGE). The use of OMT after PCI increased from 63.5% to 66% in the time period following publication of the COURAGE trial. 

The authors concluded that OMT is markedly underutilized in patients with stable CAD. The findings show there is a need to improve how the results of comparative effectiveness research are distributed and become features of care, and how research is translated into practice.