An Organized Approach to Improvement in Guideline Adherence for Acute Myocardial Infarction

BACKGROUND: Evidence-based guidelines from the American Heart Association are voluntary, and adherence is highly variable across the country. Get With The Guidelines (GWTG) is a national quality improvement program sponsored and developed by the American Heart Association. The objective of this study was to evaluate whether participation in GWTG is associated with greater adherence to guidelines for coronary artery disease (CAD). METHODS: Data on adherence to guidelines were obtained from Hospital Compare, grouping hospitals according to participation in the GWTG-CAD program on January 1, 2004: GWTG-CAD hospitals, n = 223; non-GWTG-CAD hospitals, n = 3407. The GWTG program uses a patient management tool, education, and benchmarked quality reports to improve guideline adherence. Adherence to 8 national measures, including the use of aspirin and beta-blockers early and at discharge and timeline reperfusion, was analyzed. A composite score was also calculated. Multivariable logistic regression was performed for comparing composite adherence rates between groups. RESULTS: Adherence to the overall Hospital Compare composite measure was higher in GWTG-CAD hospitals than in non-GWTG-CAD hospitals (mean SD, 89.7% 10.0% vs 85.0 15.0%; absolute increase, 4.7%; P < .001). Adherence to the GWTG-CAD performance measures (PM) composite was also higher (89.5% 11.0% vs 83.0% 18.0%; P < .001). In multivariate analysis, GWTG-CAD participation was associated with a modest absolute increase in adherence to the PM composite by 2.52% (95% confidence interval CI, 0.19%-4.85%). Larger acute myocardial infarction volume by quartile (absolute increase, 14.2%; 95% CI, 12.2%-16.3%), geographic location in the Northeast, and teaching hospital status (absolute increase, 2.87%; 95% CI, 0.43-5.32) were also associated with improved adherence to the PM composite. As a control, evaluation of unrelated quality measures for pneumonia, showed lower adherence among GWTG-CAD participating hospitals (74.8% 7.3% vs 76.1% 9.7%; P = .005). CONCLUSION: Participation in GWTG-CAD was independently associated with improvements in guideline adherence beyond that associated with public reporting.