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March 31, 2026Heart Lung and Circulation0 citationsOpen Access

Impact of Dedicated Cardiologist Input on the Rate of Prescription of Guideline-Directed Medical Therapy After Coronary Artery Bypass Graft Surgery—A Retrospective Cohort Study (The ROSS Effect)

MLMatthew LimMNMau T. NguyenPPPeter J. Psaltis

Key Result

The presence of a dedicated cardiologist on a cardiothoracic surgery unit significantly increased the prescription of high-intensity statins at discharge after CABG surgery (OR 2.7).

Study Design

Type

Cohort (n=572)

Multicenter

No

Structured PICO

Does dedicated cardiologist input improve the rate of prescription of guideline-directed medical therapy at discharge in patients undergoing coronary artery bypass graft surgery?

P
Population
572 consecutive patients undergoing coronary artery bypass graft (CABG) surgery (n=236 before in 2020, n=336 after in 2021), including semi-elective (MI within prior 21 days), elective (no MI within 21 days), and non-elective cases. Median age ~65, ~16-19% female, at a single center in South Australia.
I
Intervention
Dedicated cardiologist input assisting in perioperative management, including twice-weekly ward rounds on all preoperative and postoperative CABG patients, optimization of medical management, multidisciplinary meetings, and junior doctor education.
C
Comparator
Standard care without dedicated cardiologist input (historical cohort from the year 2020).
O
Outcome
Rate of individual guideline-directed medical therapy (GDMT) prescription at discharge (specifically high-intensity statins, dual antiplatelet therapy [DAPT], and glucagon-like peptide-1 receptor agonists [GLP1ra]).

Embedding a dedicated cardiologist in a cardiothoracic surgery unit significantly improves the prescription rates of guideline-directed medical therapies, such as high-intensity statins and DAPT, at discharge following CABG.

Main Result

Effect estimate: OR 2.7 (95% CI 1.61-4.5)

Absolute Event Rate: 86.36% vs 80.08%

p-value: p=<0.001

Limitations

  • Small sample size
  • Single center
  • Only one cardiologist involved
  • Changes in PBS subsidy criteria and contemporaneous publication of guidelines may have influenced prescribing behaviors
  • Single centre
  • Single cardiologist
  • Changes in Pharmaceutical Benefits Scheme (PBS) subsidy criteria
  • Contemporaneous publication of the 2021 ACC/AHA/SCAI revascularisation guidelines
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Cite This Study

Lim et al. (2026) conducted a cohort in Coronary artery bypass graft (CABG) surgery (n=572). Dedicated cardiologist input vs. Standard care (no dedicated cardiologist) was evaluated on Prescription of high-intensity statins at discharge (OR 2.7, 95% CI 1.61-4.5, p=<0.001). The presence of a dedicated cardiologist on a cardiothoracic surgery unit significantly increased the prescription of high-intensity statins at discharge after CABG surgery (OR 2.7).

synapsesocial.com/papers/6a025cbdedf6f4813859493ahttps://doi.org/10.1016/j.hlc.2025.11.004
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