Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use
Rationale, aims and objectives The efficacy of angiotensin‐converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. This study aimed to evaluate the effect of developing and implementing Clinical Practice Guidelines...
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| Veröffentlicht in: | Journal of evaluation in clinical practice 2003-08, Vol.9 (3), p.373-382 |
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| creator | Thilly, Nathalie Briançon, Serge Juillière, Yves Dufay, Edith Zannad, Faiez |
| description | Rationale, aims and objectives The efficacy of angiotensin‐converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. This study aimed to evaluate the effect of developing and implementing Clinical Practice Guidelines (CPGs) on the quality of care given to patients receiving ACE inhibitors for systolic heart failure.
Methods Twenty cardiology units in Lorraine (France) were randomized to an experimental (n = 10) or a control group (n = 10). In each experimental unit, doctors were involved in drafting and implementing CPGs; those at control units were not. Practice surveys were conducted in all units before and after the intervention; 723 patients with heart failure and less than 75 years old were included. The main outcome was compliance with the CPGs.
Results Before intervention, clinicians in both groups were already compliant with CPGs relating to indications and contra‐indications, adverse effects management, concomitant therapy and monitoring of biologic factors. After intervention, adherence to others CPGs was generally better in the experimental group. Compliance with the CPG relating to ACE inhibitor dose on discharge was higher in the experimental group (P = 0.003). Compliance with CPGs relating to increasing ACE inhibitors doses (P |
| doi_str_mv | 10.1046/j.1365-2753.2003.00441.x |
| format | Article |
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Methods Twenty cardiology units in Lorraine (France) were randomized to an experimental (n = 10) or a control group (n = 10). In each experimental unit, doctors were involved in drafting and implementing CPGs; those at control units were not. Practice surveys were conducted in all units before and after the intervention; 723 patients with heart failure and less than 75 years old were included. The main outcome was compliance with the CPGs.
Results Before intervention, clinicians in both groups were already compliant with CPGs relating to indications and contra‐indications, adverse effects management, concomitant therapy and monitoring of biologic factors. After intervention, adherence to others CPGs was generally better in the experimental group. Compliance with the CPG relating to ACE inhibitor dose on discharge was higher in the experimental group (P = 0.003). Compliance with CPGs relating to increasing ACE inhibitors doses (P < 0.0001) and the contents of the discharge letter (P = 0.02) improved in all units between the two periods.
Conclusions These results suggest that doctors involved in drafting and implementing CPGs are more likely to comply with them.</description><identifier>ISSN: 1356-1294</identifier><identifier>EISSN: 1365-2753</identifier><identifier>DOI: 10.1046/j.1365-2753.2003.00441.x</identifier><identifier>PMID: 12895159</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>angiotensin-converting enzyme inhibitors ; Angiotensin-Converting Enzyme Inhibitors - administration & dosage ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Cardiology Service, Hospital - standards ; clinical practice guidelines ; Female ; Heart Failure - drug therapy ; Humans ; Male ; medical audit ; Middle Aged ; Physician's Role ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - standards ; Quality of Health Care - standards ; randomized controlled trial ; Randomized Controlled Trials as Topic ; systolic heart failure</subject><ispartof>Journal of evaluation in clinical practice, 2003-08, Vol.9 (3), p.373-382</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4021-b9f984b8bb1d8020e9c088f0fa5ed366b170bf39112510a0d9148fe4cef724f53</citedby><cites>FETCH-LOGICAL-c4021-b9f984b8bb1d8020e9c088f0fa5ed366b170bf39112510a0d9148fe4cef724f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2753.2003.00441.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2753.2003.00441.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12895159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thilly, Nathalie</creatorcontrib><creatorcontrib>Briançon, Serge</creatorcontrib><creatorcontrib>Juillière, Yves</creatorcontrib><creatorcontrib>Dufay, Edith</creatorcontrib><creatorcontrib>Zannad, Faiez</creatorcontrib><title>Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use</title><title>Journal of evaluation in clinical practice</title><addtitle>J Eval Clin Pract</addtitle><description>Rationale, aims and objectives The efficacy of angiotensin‐converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. This study aimed to evaluate the effect of developing and implementing Clinical Practice Guidelines (CPGs) on the quality of care given to patients receiving ACE inhibitors for systolic heart failure.
Methods Twenty cardiology units in Lorraine (France) were randomized to an experimental (n = 10) or a control group (n = 10). In each experimental unit, doctors were involved in drafting and implementing CPGs; those at control units were not. Practice surveys were conducted in all units before and after the intervention; 723 patients with heart failure and less than 75 years old were included. The main outcome was compliance with the CPGs.
Results Before intervention, clinicians in both groups were already compliant with CPGs relating to indications and contra‐indications, adverse effects management, concomitant therapy and monitoring of biologic factors. After intervention, adherence to others CPGs was generally better in the experimental group. Compliance with the CPG relating to ACE inhibitor dose on discharge was higher in the experimental group (P = 0.003). Compliance with CPGs relating to increasing ACE inhibitors doses (P < 0.0001) and the contents of the discharge letter (P = 0.02) improved in all units between the two periods.
Conclusions These results suggest that doctors involved in drafting and implementing CPGs are more likely to comply with them.</description><subject>angiotensin-converting enzyme inhibitors</subject><subject>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Cardiology Service, Hospital - standards</subject><subject>clinical practice guidelines</subject><subject>Female</subject><subject>Heart Failure - drug therapy</subject><subject>Humans</subject><subject>Male</subject><subject>medical audit</subject><subject>Middle Aged</subject><subject>Physician's Role</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Quality of Health Care - standards</subject><subject>randomized controlled trial</subject><subject>Randomized Controlled Trials as Topic</subject><subject>systolic heart failure</subject><issn>1356-1294</issn><issn>1365-2753</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV1vFCEYhSdGYz_0LxiuvJsVBpgP401d17baVBM1Jt4QhnnpsjLDCEy760_yV8p0N_XWKw5wznkJT5YhghcEs_LVZkFoyfOi4nRRYEwXGDNGFttH2fHDxeNZ8zInRcOOspMQNhgTinn1NDsiRd1wwpvj7M9lP3p3a4YbdLZcITOsTWui82gKkHZolNHAEANauzCaKK35DR26M3GNwi5EZ41Ca5A-Ii2NnTy8RhIpO4UIHnk5dK6_Tyg3RO-sTTJ6Iy1yOtnMYFTSo5cqGgXoZjIdpFNAHdyCdWOfZqPUMj_nWfZESxvg-WE9zb69X31dXuRXn84vl2dXuWK4IHnb6KZmbd22pKtxgaFRuK411pJDR8uyJRVuNW0IKTjBEncNYbUGpkBXBdOcnmYv973pY35NEKLoTVBgrRzATUFUlLOCsiYZ671ReReCBy1Gb3rpd4JgMXMSGzHjEDMOMXMS95zENkVfHGZMbQ_dv-ABTDK82RvujIXdfxeLD6vPSaR4vo-bBGL7EJf-pygrWnHx_fpcXL9lH3-8-4JFQ_8CG3C0kQ</recordid><startdate>200308</startdate><enddate>200308</enddate><creator>Thilly, Nathalie</creator><creator>Briançon, Serge</creator><creator>Juillière, Yves</creator><creator>Dufay, Edith</creator><creator>Zannad, Faiez</creator><general>Blackwell Science Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200308</creationdate><title>Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use</title><author>Thilly, Nathalie ; Briançon, Serge ; Juillière, Yves ; Dufay, Edith ; Zannad, Faiez</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4021-b9f984b8bb1d8020e9c088f0fa5ed366b170bf39112510a0d9148fe4cef724f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>angiotensin-converting enzyme inhibitors</topic><topic>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Cardiology Service, Hospital - standards</topic><topic>clinical practice guidelines</topic><topic>Female</topic><topic>Heart Failure - drug therapy</topic><topic>Humans</topic><topic>Male</topic><topic>medical audit</topic><topic>Middle Aged</topic><topic>Physician's Role</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Quality of Health Care - standards</topic><topic>randomized controlled trial</topic><topic>Randomized Controlled Trials as Topic</topic><topic>systolic heart failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thilly, Nathalie</creatorcontrib><creatorcontrib>Briançon, Serge</creatorcontrib><creatorcontrib>Juillière, Yves</creatorcontrib><creatorcontrib>Dufay, Edith</creatorcontrib><creatorcontrib>Zannad, Faiez</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of evaluation in clinical practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thilly, Nathalie</au><au>Briançon, Serge</au><au>Juillière, Yves</au><au>Dufay, Edith</au><au>Zannad, Faiez</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use</atitle><jtitle>Journal of evaluation in clinical practice</jtitle><addtitle>J Eval Clin Pract</addtitle><date>2003-08</date><risdate>2003</risdate><volume>9</volume><issue>3</issue><spage>373</spage><epage>382</epage><pages>373-382</pages><issn>1356-1294</issn><eissn>1365-2753</eissn><abstract>Rationale, aims and objectives The efficacy of angiotensin‐converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. This study aimed to evaluate the effect of developing and implementing Clinical Practice Guidelines (CPGs) on the quality of care given to patients receiving ACE inhibitors for systolic heart failure.
Methods Twenty cardiology units in Lorraine (France) were randomized to an experimental (n = 10) or a control group (n = 10). In each experimental unit, doctors were involved in drafting and implementing CPGs; those at control units were not. Practice surveys were conducted in all units before and after the intervention; 723 patients with heart failure and less than 75 years old were included. The main outcome was compliance with the CPGs.
Results Before intervention, clinicians in both groups were already compliant with CPGs relating to indications and contra‐indications, adverse effects management, concomitant therapy and monitoring of biologic factors. After intervention, adherence to others CPGs was generally better in the experimental group. Compliance with the CPG relating to ACE inhibitor dose on discharge was higher in the experimental group (P = 0.003). Compliance with CPGs relating to increasing ACE inhibitors doses (P < 0.0001) and the contents of the discharge letter (P = 0.02) improved in all units between the two periods.
Conclusions These results suggest that doctors involved in drafting and implementing CPGs are more likely to comply with them.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>12895159</pmid><doi>10.1046/j.1365-2753.2003.00441.x</doi><tpages>10</tpages></addata></record> |
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| subjects | angiotensin-converting enzyme inhibitors Angiotensin-Converting Enzyme Inhibitors - administration & dosage Angiotensin-Converting Enzyme Inhibitors - therapeutic use Cardiology Service, Hospital - standards clinical practice guidelines Female Heart Failure - drug therapy Humans Male medical audit Middle Aged Physician's Role Practice Guidelines as Topic Practice Patterns, Physicians' - standards Quality of Health Care - standards randomized controlled trial Randomized Controlled Trials as Topic systolic heart failure |
| title | Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use |
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