Guideline adherence and outcomes in coronary heart disease and heart failure

INTRODUCTION

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 [1-14].

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 their. The more general discussion of the assessment, use and value of clinical practice guidelines can be found elsewhere. (See "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, clopidogrel, and cardiac rehabilitation programs after MI.