Improving adherence to cardiovascular guidelines: realistic transition from paper to patient

Mahtta, Dhruv; Rodríguez, Fátima; Jneid, Hani; Levine, Glenn N.; Virani, Salim S.

doi:10.1080/14779072.2020.1717335

Cited by 21 publications

(20 citation statements)

References 83 publications

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“…Integration of guideline recommendations into the daily clinical workflow at the point of care, that is, using electronic reminders in the electronic medical records or an app supporting clinical decisions, will likely enhance awareness and familiarity with CAT guidelines. 17 Choice of anticoagulant agent for CAT in contemporary clinical practice remains nonadherent to guideline recommendations. 19 In this survey, almost all respondents suggested correctly that LMWH was the primary anticoagulant choice in the department.…”

Section: Discussionmentioning

confidence: 99%

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Højen

Overvad

Nybo

et al. 2021

TH Open

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Background Treatment patterns for cancer-associated venous thrombosis (CAT) has been shown to be nonconsistent with contemporary guideline recommendations, resulting in poor patient outcomes. Objectives The study aimed to describe contemporary CAT management in Danish oncology departments and identify knowledge gaps and inconsistencies between guidelines and clinical practice. Patients and Methods A survey questionnaire in Danish was developed based on contemporary national guidelines. Using an open recruitment strategy, invitations to participate in the electronic survey were sent to physicians employed at oncology departments in Denmark in winter of 2018/2019. The questionnaire was based on current national guidelines and included 10 items with multiple choices and a free-text option to specify or comment. The questionnaire was pilot-tested by a junior and senior oncologist. Results A total of 142 physicians completed the survey, representing all Danish geographical regions and various seniority. The majority reported that CAT was treated and followed up in oncology departments. However, 36.6% of the physicians were unaware of the existence of designated cancer thrombosis guidelines. Risk of venous thrombosis was generally assessed without diagnostic scores. Almost all (98.6%) reported low-molecular-weight heparin to be first-line treatment for CAT. Treatment duration seemed wrongly influenced by subtype of venous thrombosis, and 44.5% responded that thromboprophylaxis among hospitalized patients was substantially underused. Conclusion The variability in the daily clinical management of CAT demonstrated through this survey indicates a potential to increase awareness of available guidelines, standardized use of inpatient thromboprophylaxis, and organized treatment and follow-up in a multidisciplinary setting, which would potentially improve management of CAT in Denmark.

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Section: Discussionmentioning

confidence: 99%

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Højen

Overvad

Nybo

et al. 2021

TH Open

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“…In general practice, such changes often encounter disagreement and lack of applicability for various reasons [ 28 ]. Given these multiple barriers in the health care chain, coordinated national strategies may be required to tailor and successfully implement recommended changes in CV risk management [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice

Meier

Rachamin

Rosemann

et al. 2020

JCM

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The aim of this study was to assess the impact of the 2019 published European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline on cardiovascular (CV) risk management compared with its predecessor from 2016 in a cohort in general practice. We performed a cross-sectional retrospective study with data from electronic medical records. The study cohort included 103,351 patients with known CV risk. We assessed changes in CV risk classification and low-density lipoprotein cholesterol (LDL-C) target values, the impact on LDL-C achievement rates, and the current lipid-lowering treatments. Under the 2019 ESC guideline, CV risk categories changed in 27.5% of patients, LDL-C target levels decreased in 71.4% of patients, and LDL-C target achievement rate dropped from 31.1% to 16.5%. Among non-achievers according to the 2019 guideline, 52.2% lacked lipid-lowering drugs entirely, and 41.5% had conventional drugs at a submaximal intensity. Of patients in the high-risk and very high-risk categories, at least 5% failed to achieve the LDL-C target level despite treatment at maximal intensity with conventional lipid-lowering drugs, making them eligible for PCSK-9 inhibitors. In conclusion, the 2019 ESC/EAS guideline lowered LDL-C target values for the majority of patients in general practice and halved LDL-C target achievement rates. There is still a large undeveloped potential to lower CV risk by introducing conventional lipid-lowering drugs, particularly in patients at high or very high CV risk. A substantial proportion of the patients can only achieve their LDL-C targets using PCSK-9 inhibitors, which would currently require an at least 10-fold increase in prescribing of these drugs.

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“…Dissemination strategies can be distinguished as being either active or passive. The active or dynamic dissemination approach, which is preferred among health-care practitioners, involves procedures such as proactive education of health-care practitioners, electronic reminder systems, and audit and feedback, while the passive dissemination approach is mainly based on publishing or mailing updated information (4)(5)(6)(7)(8). Taking diabetes CPGs as an example, the evidence shows that the level of diabetes CPG awareness among health-care providers, which is considered an indicator of greater adherence to the guidelines, ranges between 75% and 89% in Turkey, the United States, and China.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of investing in the industry of clinical practice guidelines for health systems

Hassanien

2021

Preprint

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Rationale: This research has been conducted to facilitate evidence-informed policymaking and to help health-care policymakers in Saudi Arabia to decide whether or not a sustainable investment in the CPG industry is socially and economically viable. Objectives: The objective is to investigate: (i) whether the clinical practice guidelines help to improve clinical practice and save costs, and (ii) the views in Saudi Arabia about implementing clinical practice guidelines. Methods: The study employs mixed methods, including: (i) a literature review to evaluate the benefits of implementing clinical practice guidelines, and (ii) an online survey to investigate views about implementing the guidelines' benefits. Results: (i) The clinical practice guidelines do help in improving clinical practice, but the evidence about their impact on saving costs is insufficient in the literature. (ii) The survey demonstrated a high level of awareness among health system actors in Saudi Arabia of the importance of having nationally unified clinical guidelines. Recommendations: Investment in the clinical practice guidelines industry seems socially and economically viable.

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Improving adherence to cardiovascular guidelines: realistic transition from paper to patient

Cited by 21 publications

References 83 publications

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice

Evaluating the impact of investing in the industry of clinical practice guidelines for health systems

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