Guideline adherence and outcomes in coronary heart disease and heart failure
- Kim A Eagle, MD, MACC
Kim A Eagle, MD, MACC
- Albion Walter Hewlett Professor of Internal Medicine
- University of Michigan
- Prashant Vaishnava, MD
Prashant Vaishnava, MD
- Professor of Medicine
- Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai
- Vijay S Ramanath, MD, FACC
Vijay S Ramanath, MD, FACC
- Clinical Assistant Professor of Medicine
- Texas A & M College of Medicine
The effective management of coronary heart disease (CHD) and heart failure (HF) is a challenge to clinicians as a consequence of their prevalence; the rapid evolution of therapies to improve outcomes; and patient, practitioner, and system obstacles to the delivery of care. As a result, clinicians often rely on professional societies for guidance in treating their patients with these illnesses.
Organizations such as the American Heart Association (AHA), the American College of Cardiology (ACC), the European Society of Cardiology, the International Society for Heart and Lung Transplantation, and the Heart Failure Society of America have developed and disseminated guidelines to aid practitioners in the management of these complex medical conditions.
The guideline committees summarize the evidence and expert opinion, and provide final, graded recommendations for patient evaluation and therapy. The guidelines address both acute inpatient and chronic outpatient care. Although some improvements in the use of these evidence-based therapies have occurred, compliance with all appropriate therapies remains suboptimal [1-15]. As an example, less than one-third of eligible patients hospitalized for HF receive guideline-recommended aldosterone antagonist therapy .
This topic will: review the evidence for the importance of guideline adherence in the management of myocardial infarction and HF; review how well these guidelines are adhered to; and provide evidence based strategies for improving adherence. The more general discussion of the assessment, use and value of clinical practice guidelines can be found elsewhere. (See "Overview of clinical practice guidelines".)
CORONARY HEART DISEASE
Evidence from randomized trials involving thousands of patients in the United States strongly supports the use of a number of interventions in most patients with CHD such as aspirin, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors, P2Y12 receptor antagonists, and cardiac rehabilitation programs after MI.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Peterson ED, Roe MT, Mulgund J, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA 2006; 295:1912.
- Newby LK, LaPointe NM, Chen AY, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation 2006; 113:203.
- Krumholz HM, Radford MJ, Wang Y, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 1998; 280:623.
- Fonarow GC, Gawlinski A, Moughrabi S, Tillisch JH. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol 2001; 87:819.
- Fonarow GC, French WJ, Parsons LS, et al. Use of lipid-lowering medications at discharge in patients with acute myocardial infarction: data from the National Registry of Myocardial Infarction 3. Circulation 2001; 103:38.
- Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol 2000; 36:2056.
- Krumholz HM, Vaccarino V, Ellerbeck EF, et al. Determinants of appropriate use of angiotensin-converting enzyme inhibitors after acute myocardial infarction in persons > or = 65 years of age. Am J Cardiol 1997; 79:581.
- Chen J, Radford MJ, Wang Y, et al. Do "America's Best Hospitals" perform better for acute myocardial infarction? N Engl J Med 1999; 340:286.
- Yan RT, Yan AT, Tan M, et al. Underuse of evidence-based treatment partly explains the worse clinical outcome in diabetic patients with acute coronary syndromes. Am Heart J 2006; 152:676.
- Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277:115.
- Smith NL, Psaty BM, Pitt B, et al. Temporal patterns in the medical treatment of congestive heart failure with angiotensin-converting enzyme inhibitors in older adults, 1989 through 1995. Arch Intern Med 1998; 158:1074.
- Komajda M, Follath F, Swedberg K, et al. The EuroHeart Failure Survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 2003; 24:464.
- Feinglass J, Martin GJ, Lin E, et al. Is heart failure survival improving? Evidence from 2323 elderly patients hospitalized between 1989-2000. Am Heart J 2003; 146:111.
- Bahit, MC, Granger, et al. Applying the evidence: opportunity in US for 80,000 additional lives saved per year. Circulation 2000; 102(suppl II):II.
- Albert NM, Yancy CW, Liang L, et al. Use of aldosterone antagonists in heart failure. JAMA 2009; 302:1658.
- Eagle KA, Montoye CK, Riba AL, et al. Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan. J Am Coll Cardiol 2005; 46:1242.
- Jani SM, Montoye C, Mehta R, et al. Sex differences in the application of evidence-based therapies for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice projects in Michigan. Arch Intern Med 2006; 166:1164.
- Calvin JE, Roe MT, Chen AY, et al. Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes. Ann Intern Med 2006; 145:739.
- Melloni C, Alexander KP, Ou FS, et al. Predictors of early discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol 2009; 104:175.
- American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, O'Gara PT, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e78.
- Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139.
- GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 2001; 141:190.
- Butler J, Arbogast PG, BeLue R, et al. Outpatient adherence to beta-blocker therapy after acute myocardial infarction. J Am Coll Cardiol 2002; 40:1589.
- Vasaiwala S, Nolan E, Ramanath VS, et al. A quality guarantee in acute coronary syndromes: the American College of Cardiology's Guidelines Applied in Practice program taken real-time. Am Heart J 2007; 153:16.
- www.crusadeqi.com/Main/HomePage.shtml (Accessed on January 12, 2007).
- Bhatt DL, Roe MT, Peterson ED, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA 2004; 292:2096.
- Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA 2005; 293:2908.
- Bavry AA, Kumbhani DJ, Rassi AN, et al. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 2006; 48:1319.
- Kaiser Permanente Care Management Institute. Secondary prevention of coronary artery disease clinical practice guideline. Oakland (CA): Kaiser Permanente Care Management Institute; 2006:117 www.guideline.gov (Accessed on June 07, 2012).
- Veterans Health Administration, Department of Defense. VA/DoD clinical practice guideline for the management of ischemic heart disease. Washington (DC): Veterans Health Administration, Department of Defense; 2003 www.guideline.gov (Accessed on June 07, 2012).
- WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:e240.
- McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33:1787.
- Fonarow GC, Yancy CW, Hernandez AF, et al. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J 2011; 161:1024.
- Fonarow GC, Yancy CW, Heywood JT, ADHERE Scientific Advisory Committee, Study Group, and Investigators. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch Intern Med 2005; 165:1469.
- Ansari M, Shlipak MG, Heidenreich PA, et al. Improving guideline adherence: a randomized trial evaluating strategies to increase beta-blocker use in heart failure. Circulation 2003; 107:2799.
- Komajda M, Lapuerta P, Hermans N, et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 2005; 26:1653.
- Shibata MC, Nilsson C, Hervas-Malo M, et al. Economic implications of treatment guidelines for congestive heart failure. Can J Cardiol 2005; 21:1301.
- Cleland JG, Cohen-Solal A, Aguilar JC, et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 2002; 360:1631.
- Komajda M, Bouhour JB, Amouyel P, et al. Ambulatory heart failure management in private practice in France. Eur J Heart Fail 2001; 3:503.
- Veterans Health Administration, Department of Veterans Affairs. The pharmacologic management of chronic heart failure. Washington (DC): Veterans Health Administration, Department of Veterans Affairs; 2003:45 www.guideline.gov (Accessed on June 07, 2012).
- Center for Medicare and Medicaid Services. Premier Hospital Quality Incentive Demonstration www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp (Accessed on May 09, 2007).
- Lambert-Kerzner A, Del Giacco EJ, Fahdi IE, et al. Patient-centered adherence intervention after acute coronary syndrome hospitalization. Circ Cardiovasc Qual Outcomes 2012; 5:571.
- Ellerbeck EF, Jencks SF, Radford MJ, et al. Quality of care for Medicare patients with acute myocardial infarction. A four-state pilot study from the Cooperative Cardiovascular Project. JAMA 1995; 273:1509.
- O'Connor GT, Quinton HB, Traven ND, et al. Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA 1999; 281:627.
- Vaccarino V, Horwitz RI, Meehan TP, et al. Sex differences in mortality after myocardial infarction: evidence for a sex-age interaction. Arch Intern Med 1998; 158:2054.
- Allison JJ, Kiefe CI, Centor RM, et al. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med 1996; 11:736.
- Mehta RH, Montoye CK, Gallogly M, et al. Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA 2002; 287:1269.
- LaBresh KA, Ellrodt AG, Gliklich R, et al. Get with the guidelines for cardiovascular secondary prevention: pilot results. Arch Intern Med 2004; 164:203.
- Mehta RH, Montoye CK, Faul J, et al. Enhancing quality of care for acute myocardial infarction: shifting the focus of improvement from key indicators to process of care and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Michigan: Flint and Saginaw Expansion. J Am Coll Cardiol 2004; 43:2166.
- Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA 1998; 279:1351.
- AHA, ACC, National Heart, Lung, and Blood Institute, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.
- Kumbhani DJ, Fonarow GC, Cannon CP, et al. Predictors of adherence to performance measures in patients with acute myocardial infarction. Am J Med 2013; 126:74.e1.
- Mazzini MJ, Stevens GR, Whalen D, et al. Effect of an American Heart Association Get With the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. Am J Cardiol 2008; 101:1084.
- Mehta RH, Roe MT, Chen AY, et al. Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative. Arch Intern Med 2006; 166:2027.
- Roe MT, Peterson ED, Newby LK, et al. The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J 2006; 151:1205.
- Patel MR, Chen AY, Roe MT, et al. A comparison of acute coronary syndrome care at academic and nonacademic hospitals. Am J Med 2007; 120:40.
- Rogers WJ, Bowlby LJ, Chandra NC, et al. Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the National Registry of Myocardial Infarction. Circulation 1994; 90:2103.
- Rosenthal MB, Landon BE, Normand SL, et al. Pay for performance in commercial HMOs. N Engl J Med 2006; 355:1895.
- Pham HH, Schrag D, O'Malley AS, et al. Care patterns in Medicare and their implications for pay for performance. N Engl J Med 2007; 356:1130.
- CORONARY HEART DISEASE
- Efficacy of CHD guideline adherence
- Predictors of guideline non-adherence
- Assessment of CHD guideline adherence
- Guidelines for CHD management in ambulatory settings
- HEART FAILURE
- Beta blockers in HF
- Efficacy of HF guideline adherence
- Assessment of HF guideline adherence
- Guidelines for heart failure management in ambulatory settings
- STRATEGIES TO IMPROVE GUIDELINE ADHERENCE
- Quality improvement initiatives
- - GAP program
- - GWTG program
- - CRUSADE registry
- Government initiatives