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.
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- 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