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Editorials

Monitoring Adherence to Guidelines

Jay N. Cohn, MD

From the University of Minnesota Medical School, Minneapolis, Minn.

Correspondence to Jay N. Cohn, MD, Cardiovascular Division, Mayo Mail Code 508, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455. E-mail cohnx001@umn.edu

Key Words: Editorials • heart failure • outpatients • quality of care

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In our current medical environment, which is characterized by oversight, accountability, practice guidelines, and documentation, it was inevitable that practice patterns would be monitored to rank compliance with guidelines as an index of the quality of care. It is a small step to a "pay-for-performance" approach, which is well intentioned because it uses data from clinical trials and guideline recommendations to reward physicians who are using treatment strategies known to be effective. Such an approach is aimed at identifying and reforming doctors who do not use "evidence-based" therapy.

Article see p 98

In this issue of Circulation: Heart Failure, Fonarow and colleagues¹ review the data on >15000 patients with heart failure cared for in 167 outpatient cardiology practices in the United States. The results can be viewed as encouraging or discouraging, depending on your expectations, and as an optimistic step in the right direction to ensure quality care or as a depressing retreat from individualized care, depending on your point of view.

If one assumes that an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker and a β-blocker are mandated therapy for patients with heart failure and a low ejection fraction, nearly 80% of patients were receiving appropriate therapy. That might seem encouraging, given prior lower figures for compliance and the evidence that other diseases, such as hypertension, are being treated inadequately.² Nevertheless, whereas hypertension treatment is judged by blood pressure response, the analysis by Fonarow et al¹ of drug therapy for heart failure is limited to whether a . . . [Full Text of this Article]

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Circ Heart Fail 2008 1: 98-106. [Abstract] [Full Text] [PDF]