Evaluating the outcomes of >600000 CABG patients in the Society of Thoracic Surgeons Database from 1996 to 1999, these authors noted that patients who received -blockers before surgery had significantly lower 30-day mor- tality rates compared with those who did not (adjusted OR, 0.94; 95% CI, 0.91 0.97). However, it remained for a number of quality-improvement projects that emerged in the early-to-mid-2000s to link sec- ondary prevention and -blockade therapy in CABG. These studies created the environment for attention to and adoption of -blocker therapy after CABG. Foody et al191 documented in a national database that only 61.5% of CABG patients received -blocker therapy after presenting with MI between 1998 and 1999, which was lower than the non-CABG patient population. This study laid the foundation for establishing baseline secondary prevention benchmarks for aspirin, angio- tensin-converting enzyme (ACE) inhibitors, and lipid-lower- ing medications. With this study as a call to action, a number of regional and national quality-improvement efforts using a variety of techniques established increases in postdischarge -blocker therapy. The Alabama CABG project demonstrated an increase in -blocker therapy at discharge from 65% to 78% Similarly, Williams et al193 reported a significant increase in adherence for all secondary preven- tion medications, including -blocker therapy, in a national quality-improvement program. Single centers during the same time frame were able to achieve even more impressive results, with the University of Kentucky improving its -blocker use after CABG from 95% to 100% by implementing an intensive Finally, in a study exploring the Get With The Guidelines database, investigators noted that 90.8% of patients were discharged on -blocker therapy after Interestingly, this was less than comparable patients discharged after percutaneous coronary intervention. 