Get with The Guidelines and Guideline Directed Medical Therapy: Why it Matters

Abstract

Listen

Translate article

Despite therapeutic advances, the epidemic of heart failure (HF) is as challenging as ever. Gaps in prescribing, dose intensification, and adherence leave the vast majority of patients on suboptimal treatment regimens. Without a serious commitment to improving processes of care, many of the scientific advances now available to patients with HF are lost. The tools of process improvement bring operational processes and medical evidence together through guidelines, data standards, quality metrics and performance measures, national registries and benchmarking. Participation in national clinical registries/quality improvement programs offers a method for accurately assessing processes and outcomes and offers feedback on how individual hospital and clinician practices compare with their peers through benchmarking performance against aggregate national or similar hospital outcomes following adjustment for case mix. These quality improvement programs also help share and disseminate best practices and process improvement techniques that can be tailored and implemented locally. A notable example of a national clinical registries/quality improvement program in HF is the American Heart Association's Get With The Guidelines. GWTG-HF is an in-hospital program for improving care by promoting consistent adherence to the latest scientific treatment guidelines. Hospitals participating in GWTG-HF have been able to achieve and sustain high rates of use of the full set of guideline-directed medical therapies, along with provision of HF patient education. Quality of care and clinical outcomes for participating hospitals have been shown to be superior to that of comparable hospitals not participating. It is estimated that if process improvement for HF treatment were implemented optimally more than 100,000 lives a year of HF patients in US each could be saved. Despite therapeutic advances, the epidemic of heart failure (HF) is as challenging as ever. Gaps in prescribing, dose intensification, and adherence leave the vast majority of patients on suboptimal treatment regimens. Without a serious commitment to improving processes of care, many of the scientific advances now available to patients with HF are lost. The tools of process improvement bring operational processes and medical evidence together through guidelines, data standards, quality metrics and performance measures, national registries and benchmarking. Participation in national clinical registries/quality improvement programs offers a method for accurately assessing processes and outcomes and offers feedback on how individual hospital and clinician practices compare with their peers through benchmarking performance against aggregate national or similar hospital outcomes following adjustment for case mix. These quality improvement programs also help share and disseminate best practices and process improvement techniques that can be tailored and implemented locally. A notable example of a national clinical registries/quality improvement program in HF is the American Heart Association's Get With The Guidelines. GWTG-HF is an in-hospital program for improving care by promoting consistent adherence to the latest scientific treatment guidelines. Hospitals participating in GWTG-HF have been able to achieve and sustain high rates of use of the full set of guideline-directed medical therapies, along with provision of HF patient education. Quality of care and clinical outcomes for participating hospitals have been shown to be superior to that of comparable hospitals not participating. It is estimated that if process improvement for HF treatment were implemented optimally more than 100,000 lives a year of HF patients in US each could be saved.