Integrating cardiology and pharmacology in cardiac ERAS increased statin use from 76.6% to 89%, halved GDMT in EF ≤40%, and cut opioid discharge prescriptions from 15.4% to 5.38%.
Does a multidisciplinary perioperative strategy integrating clinical cardiology and pharmacology improve GDMT adherence and secondary prevention in elective cardiac surgery patients?
A multidisciplinary ERAS program integrating cardiology and pharmacology significantly improved statin prescription rates and reduced opioid use at discharge in elective cardiac surgery patients.
Abstract Background Recent studies highlight the clinical and logistical benefits of involving cardiology specialists in managing heart failure hospitalizations 1,2. Additionally, initiating Guideline-Directed Medical Therapy (GDMT) during hospital stays has been shown to improve long-term adherence 3. As cardiac surgery increasingly involves older patients with more comorbidities, multidisciplinary procedures are becoming more prevalent 4,5. Standardizing hospital care, ensuring GDMT adherence, and reinforcing secondary prevention are crucial to optimizing outcomes, yet maintaining compliance with evidence-based practices remains a challenge. The integration of clinical cardiology and pharmacology into perioperative care is expected to enhance GDMT adherence, optimize discharge prescriptions, and improve patient recovery. In response, a Cardiac ERAS program was introduced and implemented from 2022 to 2023, coordinated by a cardiologist working closely with a multidisciplinary team, with the objective of refining perioperative management in elective cardiac surgery. Purpose To evaluate the impact of a multidisciplinary perioperative strategy integrating clinical cardiology and pharmacology on GDMT adherence and secondary prevention in the context of ERAS protocol implementation between 2023 and 2025, using a retrospective comparison with a 2019 cohort. Methods Retrospective analysis within the ongoing local cardiac ERAS registry, including an ERAS cohort (2023-2025) of 353 patients (median age 64 years, 24.9% female) and a pre-ERAS cohort (2019) of 162 elective cardiac surgery patients (median age 67 years, 30.9% female). All elective cardiac procedures were included, encompassing CABG, valvular, aortic, and combined surgeries. Interventions involved a comprehensive medication review, pharmacological optimization (GDMT, lipid management, anticoagulation), real-time treatment adjustments, and secondary prevention strategies. Key discharge metrics included statin therapy in CABG patients, opioid prescriptions at discharge, and the prescription of three heart failure medications (anti-aldosterone, IEC-ARB or ARNI, and beta-blocker) in patients with LVEF 50%. The study was approved by the local ethics committee, and patients who refused general consent for data reuse were excluded. Results Among patients with EF ≤40% (N=18 per group), GDMT adherence was observed in 27.8% of pre-ERAS patients and 50.0% of ERAS patients (p=0.305). In CABG patients (N=77 pre-ERAS, N=136 ERAS), statin prescription increased from 76.6% to 89.0% (p=0.028). Opioid prescriptions at discharge declined from 15.4% to 5.38% (p0.001). Conclusion A multidisciplinary approach integrating clinical cardiology and pharmacology significantly improved GDMT adherence and secondary prevention in ERAS cardiac surgery patients. This strategy enhanced pharmacological management, reduced opioid prescriptions, and reinforced adherence to evidence-based practices.
Verdugo-Marchese et al. (2025) studied this question. Integrating cardiology and pharmacology in cardiac ERAS increased statin use from 76.6% to 89%, halved GDMT in EF ≤40%, and cut opioid discharge prescriptions from 15.4% to 5.38%.