"Get With The Guidelines" programs improve care

After one year - Get With The GuidelinesSM programs used in hospitals significantly improved care for almost 30,000 coronary artery disease patients of all ages and sexes, according to research reported at the American Heart Association's Scientific Sessions 2005.

"Men and women, young and old, all showed dramatic improvements in care," said Gray Ellrodt, M.D., lead author of the study and chair of the department of medicine at Berkshire Medical Center in Pittsfield, Mass., and a professor of medicine at the University of Massachusetts in Worcester, Mass.

The American Heart Association developed Get With The Guidelines, a quality improvement program that encourages hospitals to consistently treat and discharge patients according to evidence-based guidelines. Get With The Guidelines is designed to close the treatment gap and reduce disparities in the acute care and secondary prevention of cardiovascular diseases.

"We feel the program has become more refined over time. We know hospitals that participate for more than two years get even better at it. So we are going to continue following these patients to see if further improvements occur. The beauty of Get With The Guidelines is that it tries to take away the bias that is built into the medical system for some unknown reason."

Get With The Guidelines–Coronary Artery Disease (GWTG–CAD) is a Web-based continuous quality improvement program that:

• Provides care teams with instant access to data to guide their treatment decisions.
• Prints American Heart Association pamphlets on CAD care so patients get educational materials immediately.
• Sends quarterly reports to hospitals and care teams on how well they're meeting key treatment goals set by American Heart Association/American College of Cardiology guidelines.

For the study, researchers assessed data from 198 hospitals and 29,713 patients, using a composite performance measure that included aspirin use in the hospital and directions for aspirin therapy at discharge, as well as use of beta blockers, ACE inhibitor prescriptions for heart attack patients upon discharge, smoking cessation counseling and cholesterol-lowering therapy in appropriate patients.

The control group is baseline data (the initial information collected prior to the implementation of an intervention) on the care of nearly 17,750 patients treated at the same hospitals before they joined the GWTG–CAD program. Across all groups, baseline compliance with AHA/ACC guidelines ranged from 75.5 percent among women over age 75 to 79.8 percent for men under age 65. The rate of meeting treatment goals was slightly lower for women and the elderly.

The baseline data is a good control because studies have shown that patients who have just had a heart attack or had procedures to widen clogged arteries are highly motivated to make lifestyle changes and highly compliant with therapies given at discharge, Ellrodt said.

After four quarters using the GWTG–CAD program, treatment had significantly improved for all groups. Adherence rose to:

• 87.6 percent for men and 84.1 percent for women under age 65.
• 86.5 percent for men and 83 percent for women ages 65-74.
• 84.9 percent for men and 82.8 percent for women 75 and older.

The greatest change was found in men over age 75, whose adherence rose 8.8 percent and in women under age 65, who had an 8 percent increase.

Researchers said some disparities in care still remained.

The lowest increase of 7 percent, was found in women ages 65–74, and 7.3 percent in women ages 75 and above. Those lingering disparities are the subject of on-going studies.

"Why does the gap persist even though we improved the care for everybody? We're going to look at a larger database and look at performance at medical centers for two years to see if we can erase or eliminate the differences," Ellrodt said. "Ideally, it should have been 100 percent for everybody. We want to improve care for everyone and eliminate the differences related to gender and age."