The burden of cardiovascular disease is rising in American Indians. Compared to other racial and ethnic groups, American Indians have greater risk factors, prevalence, and mortality rates for cardiovascular disease compared to other races (Eschiti, 2005), including diabetes mellitus, obesity, hypertension, and tobacco use (Kurian & Cardarelli, 2007). With respect to American Indians undergoing surgical revascularization with coronary artery bypass grafting, mortality rates are reported to be higher than the general population and other ethnic groups (Nallamothu et al., 2001). The present project evaluates current algorithm driven protocols in relation to discharge medications and adherence to follow-up care in this at-risk population. While the need for patient education is vital to the overall reduction of mortality related to coronary artery disease in all populations, we must first ensure health care providers are providing care using evidenced-based practice guideline. With the American College of Cardiology Foundation and American Heart Association evidenced-based guideline, there should be an improvement in medical therapy and follow-up care, which will ultimately affect the median and long-term patient outcomes. A retrospective chart review of patients undergoing surgical coronary revascularization at Sanford Health Fargo, North Dakota from 2008 to 2013 was performed. Of the 204 patients identified, 100 were American Indian. A 1:1 comparison with individuals of non-American Indian decent was completed. Medications on discharge and follow-up medical appointments were evaluated and mortality within one year was assessed. The Americans Indians patients were younger (61.3 vs 64.1 years; p<0.0306); had significantly higher rates of diabetes mellitus and insulin-dependent diabetes mellitus, and were significantly more likely to be active tobacco smokers. American Indians were less likely to be discharged on a beta-blocker (90.0% vs 97.12%; p=<0.0375). Postoperative medical follow-up in the American Indian patients had statistically significant deficiencies when compared to non-American Indians follow-up care with a primary care provider. Overall, the results of this project suggest a greater need for health care providers to adhere to American College of Cardiology Foundation and American Heart Association guideline directed medical therapy following coronary artery bypass graft surgery and improvements in outpatient medical care including follow-up.