GWTG Works: New Study Shows Adherence to CAD Guidelines Reaps Benefits

September 10, 2008

September 10, 2008 (Cleveland, OH) — A new study has shown that US hospitals participating in the American Heart Association (AHA) Get With the Guidelines--Coronary Artery Disease (GWTG-CAD) program provide superior quality of care in acute myocardial infarction (AMI), resulting in better clinical outcomes [ color="blue">1]. Dr Wiliam R Lewis (Case Western Reserve University, Cleveland, OH) and colleagues report the first head-to-head comparison of care between GWTG and non-GWTG hospitals in the September 8, 2008 issue of the Archives of Internal Medicine.


Senior author Dr Gregg C Fonarow (Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles) told heartwire that although prior studies have shown that hospitals participating in GWTG-CAD have had progressive improvements in quality of care for AMI over time, the question remained as to whether these improvements would have occurred anyway. "This study allowed us to compare, in a concurrent time frame, the quality of care being provided in hospitals and look at whether it was participation in GWTG-CAD per se that was influencing the quality of care provided vs just some other characteristic of the hospital," he explained.

They found that participation per se was a defining factor in how well the hospitals perform. "We believe these data show that GWTG-CAD works and will be helpful in improving quality of care for the nation's hospitals. We hope this will encourage participation in GWTG-CAD, and we're hopeful that now the study is published in the peer-reviewed literature, it will serve as a call to action for more hospitals to join with this effort."

GWTG Program Itself Responsible for Success

Lewis et al used the Hospital Compare database to look at 223 hospitals participating in GWTG-CAD and contrasted them with 3407 nonparticipating hospitals. Adherence to eight national measures, including the use of aspirin and beta blockers early and at discharge, was analyzed, and a composite score was also calculated. The researchers also compared the two groups of hospitals on a noncardiovascular performance measure, pneumonia care, as a form of control.

They found clinically relevant and statistically significant differences in a number of the quality-of-care measures between the two hospital groups, "and GWTG was independently associated with a better quality of care," Fonarow said.

Adherence to the overall Hospital Compare composite measure was higher in GWTG-CAD hospitals than in non-GWTG-CAD institutions: 89.7% vs 85.0% (p<0.001). Adherence to the GWTG-CAD performance-measures composite was also higher among those participating in the program: 89.5% vs 83.0% (p<0.001).

Larger AMI volume by quartile, geographic location in the Northeast, and teaching-hospital status were also associated with improved adherence to the performance-measures composite.

To rule out selection bias, they also looked at pneumonia-care outcomes but found that for this variable, hospitals in GWTG-CAD performed worse than those not in the program (74.8% adherence for quality measures for pneumonia compared with 76.5% among non-GWTG hospitals; p=0.005).

"It appeared to be the GWTG program itself that was influencing the higher rate of performance on these very important AMI process measures," Fonarow explained to heartwire . This proves that by virtue of participating in the program, hospitals can provide higher quality of care, he added.

Data Can Help Overcome Barriers to Participation

He explained that there are a number of potential barriers to taking part in such programs: "It takes time and resources and is a matter of identifying individual physicians and nurses within hospitals who want to take this on and lead the effort. Hospitals faced with a number of these [programs] may gravitate toward doing the minimum that is required to be nationally mandated."

He hopes that "data like this can help to overcome the barriers to show that active participation in GWTG-CAD allows for a meaningful differential in quality of care. Research such as this is important in encouraging further participation."

Fonarow disclosed receiving research grants from GlaxoSmithKline, Medtronic, Pfizer, and the National Institutes of Health ; having been on the speaker's bureau for or having received honoraria from AstraZeneca, GlaxoSmithKline, Merck, Pfizer, Sanofi-Aventis, Schering-Plough, Novartis, and King; and having been a consultant for GlaxoSmithKline, Schering-Plough, AstraZeneca, Scios, and Amgen. Disclosures for the coauthors are listed in the paper.

  1. Lewis WR, Peterson ED, Cannon CP, et al. An organized approach to improvement in guideline adherence for acute myocardial infarction. Results with the get with the guidelines quality improvement program. Arch Intern Med 2008; 168: 1813-1819.

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