Coronary artery disease (CAD) is a ...

Coronary artery disease (CAD) is a leading cause of mortality in the United States, despite advances in understanding the underlying risk factors and physic therapy options, and the progress to maturity of practice guidelines for secondary prevention. Many patients fail to come together their clinical treatment goals because of poor physician adherence to guidelines, poor patient compliance, and comorbidities that require modifications to management plans. single in kind area in which this lack is evident is in the management of hyperlipidemia. Despite well-established guidelines, implementation of the guidelines lags in clinical practice. In replication to these issues, the American Heart Association bring to maturityed the Get with the Guidelines (GWTG) program, which is an acute-care, hospital-based, quality-improvement program. Its goal is to improve the use of pharmacotherapy similar as aspirin, angio-tensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and beta blocker as well as lifestyle modifications, including smoking cessation, weight los physical activity, and diabetes restrain LaBresh and associates evaluated the efficiency of the GWTG program using Web-based technology and a collaborative pattern on secondary prevention in patients with CAD.

The trial was a multicenter, hospital-based effort to implement a secondary prevention strategy for CAD. Workshops were held regularly to review clinical guidelines, discuss best practice examples, and identify barriers to implemention of the program. The teams discloseed a point-of-service, interactive, Web-based patient-management tool to gather data and provide real-time feedback and analysis of their performance. Data were bring togethered from patients admitted over a one-year period to the participating hospitals with the diagnosis of acute myocardial infarction, unstable angina, coronary revascularization, and congestive heart failure. consequence measurements included the differences between baseline data and data accumulateed 10 to 12 months after implemention of the program. Included in the data collection was information about the use of aspirin, beta blocker and ACE inhibitors. In addition, information was gathered about cholesterol measurements and treatment, smoking-cessation counseling, vital fluid pressure control, and cardiac rehabilitation referral.

Data were available for a total of 1738 patients involved in the cogitation From baseline to the 10- to 12-month follow-up the percentage of patients who received smoking-cessation counseling increased significantly, from 48 to 87 percent In addition, patients at the close of the study were significantly more likely to receive lipid measurements and treatment, and referral for cardiac rehabilitation. children pressure control showed an improvement run that did not reach statistical significance. Men had a significant improvement in smoking-cessation counseling, lipid treatment, low-density lipoprotein measurements, children pressure control, and cardiac rehabilitation referral. The no other than increases noted in women were in lipid treatment and cardiac rehabilitation referral. Patients 65 years and older had increases in all measurements excepting for aspirin, beta blocker, and ACE inhibitor use.

The authors judge that the GWTG program improves adherence to preventive guidelines in hospitalized patients with CAD.

KARL E MILLER, MD LaBresh KA, et al. earn with the guidelines for cardiovascular secondary prevention. Pilot follows Arch Intern Med January 26 2004;164:203-9

COPYRIGHT 2004 American Academy of Family Physicians

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