The essence of effective treatment and compliance is simplicity

In recent years, several international bodies of experts have established extensive guidelines for the prevention and treatment of coronary heart disease (CHD) that clearly define the importance of altering patients' lifestyles and administering therapeutic agents that positively affect disease progression. However, surveys of actual clinical practice have revealed that many of the key recommendations within these guidelines are not being implemented. The causes of this current undertreatment of CHD, although complex and varied, can be tackled in two main ways: by increasing physician adherence to guideline recommendations and by increasing patient compliance to medication. Experience shows that the existence of guidelines is not enough to ensure that physicians consistently apply the messages they contain. Difficulties in extrapolating clinical trial data to their patients, insufficient knowledge of the disease area, time constraints, and economic issues are a few examples of the barriers that may prevent physicians from achieving best practice. One way of addressing at least some of these problems may be to make greater use of nurses and other healthcare professionals, both in hospitals and in the primary care setting. Physicians must also be persuaded to employ long-term management and prevention strategies, as opposed to focusing on the short-term perspective. In doing so, the use of highly efficacious agents with a low incidence of associated adverse events will be the most successful in terms of maintaining patient compliance.