Interventions to Improve Adherence to Cardiovascular Disease Guidelines: a Systematic Review

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2015 Oct 24

PMID 26494597

Citations 25

Authors

Rebecca A Jeffery

Matthew J To

Gabrielle Hayduk-Costa

Adam Cameron

Cameron Taylor

Colin Van Zoost

Jill A Hayden

Affiliations

Soon will be listed here.

Abstract

Background: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes.

Methods: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome.

Results And Discussion: We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]).

Conclusions: Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions.

Citing Articles

Implementation of a Sudden Cardiac Death Risk Prediction Tool in Clinical Practice Through Electronic Health Records (INSERT-HCM Study Design).

Papaz T, Seto E, Anthony S, Pol S, Hayeems R, Barwick M CJC Open. 2025; 7(1):46-52.

PMID: 39872640 PMC: 11763851. DOI: 10.1016/j.cjco.2024.10.002.

Development and validation of interprofessional health education module for the management of gestational diabetes mellitus.

Shetty A, Reddy M, Patil N, Kumaran E, Satyanarayana P, Sheela S J Educ Health Promot. 2024; 13:135.

PMID: 38784269 PMC: 11114521. DOI: 10.4103/jehp.jehp_920_23.

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map.

Shaw L, Briscoe S, Nunns M, Lawal H, Melendez-Torres G, Turner M BMJ Open. 2024; 14(2):e072502.

PMID: 38401904 PMC: 10895245. DOI: 10.1136/bmjopen-2023-072502.

Development of the Cardiovascular Assessment Screening Program (CASP) using the qualitative findings of a mixed methods study and applying the TDF to address the barriers of and facilitators to comprehensive screening for cardiovascular disease.

Bruneau J, Parsons K, Moralejo D, Donovan C BMC Prim Care. 2023; 24(1):65.

PMID: 36882713 PMC: 9990229. DOI: 10.1186/s12875-023-02022-8.

Task Sharing for Managing Common Noncommunicable Disease in a Nurse Led Noncommunicable Diseases Clinic in Peri-Urban Community of Chandigarh.

Kashyap N, Kavita K, Kumari Saini S, Singh A Indian J Community Med. 2023; 47(4):596-599.

PMID: 36742956 PMC: 9891051. DOI: 10.4103/ijcm.ijcm_1048_21.

References

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur Heart J. 2012; 33(13):1635-701. DOI: 10.1093/eurheartj/ehs092. View

Bertoni A, Bonds D, Chen H, Hogan P, Crago L, Rosenberger E . Impact of a multifaceted intervention on cholesterol management in primary care practices: guideline adherence for heart health randomized trial. Arch Intern Med. 2009; 169(7):678-86. PMC: 2937279. DOI: 10.1001/archinternmed.2009.44. View

Gill J, Chen Y, Glutting J, Diamond J, Lieberman M . Impact of decision support in electronic medical records on lipid management in primary care. Popul Health Manag. 2009; 12(5):221-6. DOI: 10.1089/pop.2009.0003. View

Tobe S, Stone J, Brouwers M, Bhattacharyya O, Walker K, Dawes M . Harmonization of guidelines for the prevention and treatment of cardiovascular disease: the C-CHANGE Initiative. CMAJ. 2011; 183(15):E1135-50. PMC: 3193113. DOI: 10.1503/cmaj.101508. View

Steyn K, Lombard C, Gwebushe N, Fourie J, Everett-Murphy K, Zwarenstein M . Implementation of national guidelines, incorporated within structured diabetes and hypertension records at primary level care in Cape Town, South Africa: a randomised controlled trial. Glob Health Action. 2013; 6:20796. PMC: 3784670. DOI: 10.3402/gha.v6i0.20796. View

Grimshaw J, Russell I . Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993; 342(8883):1317-22. DOI: 10.1016/0140-6736(93)92244-n. View

van Steenkiste B, van der Weijden T, Stoffers H, Kester A, Timmermans D, Grol R . Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians. Eur J Cardiovasc Prev Rehabil. 2007; 14(1):44-50. DOI: 10.1097/01.hjr.0000239475.71805.1e. View

Feldman R, Zou G, Vandervoort M, Wong C, Nelson S, Feagan B . A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial. Hypertension. 2009; 53(4):646-53. DOI: 10.1161/HYPERTENSIONAHA.108.123455. View

Bonds D, Hogan P, Bertoni A, Chen H, Clinch C, Hiott A . A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study. Am Heart J. 2009; 157(2):278-84. PMC: 2929708. DOI: 10.1016/j.ahj.2008.09.021. View

10.

Eccles M, Hawthorne G, Whitty P, Steen N, Vanoli A, Grimshaw J . A randomised controlled trial of a patient based Diabetes Recall and Management System: the DREAM trial: a study protocol [ISRCTN32042030]. BMC Health Serv Res. 2002; 2(1):5. PMC: 101376. DOI: 10.1186/1472-6963-2-5. View

11.

Peters-Klimm F, Muller-Tasch T, Remppis A, Szecsenyi J, Schellberg D . Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice--results from a cluster-randomized controlled trial of implementation of a clinical practice guideline. J Eval Clin Pract. 2008; 14(5):823-9. DOI: 10.1111/j.1365-2753.2008.01060.x. View

12.

Browner W, Baron R, Solkowitz S, Adler L, Gullion D . Physician management of hypercholesterolemia. A randomized trial of continuing medical education. West J Med. 1994; 161(6):572-8. PMC: 1022738. View

13.

Berwanger O, Guimaraes H, Laranjeira L, Cavalcanti A, Kodama A, Zazula A . Effect of a multifaceted intervention on use of evidence-based therapies in patients with acute coronary syndromes in Brazil: the BRIDGE-ACS randomized trial. JAMA. 2012; 307(19):2041-9. DOI: 10.1001/jama.2012.413. View

14.

ROSSI R, Every N . A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med. 1997; 12(11):672-8. PMC: 1497186. DOI: 10.1046/j.1525-1497.1997.07140.x. View

15.

Goldstein M, Lavori P, Coleman R, Advani A, Hoffman B . Improving adherence to guidelines for hypertension drug prescribing: cluster-randomized controlled trial of general versus patient-specific recommendations. Am J Manag Care. 2005; 11(11):677-85. View

16.

Eaton C, Parker D, Borkan J, McMurray J, Roberts M, Lu B . Translating cholesterol guidelines into primary care practice: a multimodal cluster randomized trial. Ann Fam Med. 2011; 9(6):528-37. PMC: 3252191. DOI: 10.1370/afm.1297. View

17.

Ornstein S, Jenkins R, Nietert P, Feifer C, Roylance L, Nemeth L . A multimethod quality improvement intervention to improve preventive cardiovascular care: a cluster randomized trial. Ann Intern Med. 2004; 141(7):523-32. DOI: 10.7326/0003-4819-141-7-200410050-00008. View

18.

Hayes R, Baker D, Luthi J, Baggett R, McClellan W, Fitzgerald D . The effect of external feedback on the management of medicare inpatients with congestive heart failure. Am J Med Qual. 2002; 17(6):225-35. DOI: 10.1177/106286060201700605. View

19.

Tierney W, Overhage J, Murray M, Harris L, Zhou X, Eckert G . Effects of computerized guidelines for managing heart disease in primary care. J Gen Intern Med. 2003; 18(12):967-76. PMC: 1494965. DOI: 10.1111/j.1525-1497.2003.30635.x. View

20.

Rood E, Bosman R, van der Spoel J, Taylor P, Zandstra D . Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc. 2004; 12(2):172-80. PMC: 551549. DOI: 10.1197/jamia.M1598. View