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Guideline adherence and outcomes in coronary heart disease and heart failure

Authors
Kim A Eagle, MD, MACC
Prashant Vaishnava, MD
Vijay S Ramanath, MD, FACC
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Brian C Downey, MD, FACC

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 [1-15]. As an example, less than one-third of eligible patients hospitalized for HF receive guideline-recommended aldosterone antagonist therapy [15].

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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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
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