Lack of implementation of guidelines recommendations for coronary revascularization in stable patients with complex disease is associated with high rates of incomplete revascularization

Marino, Marcello; Leonardi, Sergio; Ferrario, Maurizio; Musumeci, Giuseppe; Tarantini, Giuseppe; Bettari, Luca; Lettino, Maddalena; Luca, Leonardo De; Varbella, Ferdinando; Servi, Stefano De

doi:10.1007/s00380-019-01459-1

Cited by 3 publications

(7 citation statements)

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“…The majority of the studies (n=11) evaluated adherence to the guidelines published by the American College of Cardiology (ACC)/the American Heart Association (AHA) and the European Society of Cardiology. Specifically, the studies assessed adherence to recommendations on the performance of a revascularisation in general, 23 30 a CABG, 22 24 29 a PCI/PTCA, 22 24 25 27 an ad hoc PCI, 25 26 a PCI with prior heart team discussion 26 28 and a CA. 19–21 …”

Section: Resultsmentioning

confidence: 99%

“…The extent of guideline adherence depended on the procedure in question, and ranged from: 67% to 91% for PCI/PTCA, 22 24 25 27 17% to 20% for ad hoc PCI, 25 26 10% to 19% for PCI with prior heart team discussion, 26 28 49% to 98% for CABG, 22 24 29 40% to 94% for revascularisation in general 23 30 and 52% to 79% for CA. 19–21 An overview of the methods used to assess guideline adherence is presented in table 1 (for detailed information, see online supplemental file 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…The study results differ in the extent of guideline adherence, particularly between studies that did not examine the same treatment decisions. The lowest extent of adherence was observed for a PCI with prior heart team discussion (10%) 26 28 and an ad hoc PCI (17%), 25 while the highest extent of adherence was observed for CABG (98%). 29 Since a high level of evidence has a positive impact on the implementation of guidelines in clinical practice, 8 22 this variation might be explained by the low level of evidence for the recommendations for PCI with prior heart team discussion and ad hoc PCI (ie, consensus of experts or small/retrospective studies and registries).…”

Section: Discussionmentioning

confidence: 98%

“…Those studies that examined the same treatment decision showed less variation than those that evaluated different treatment decisions. The extent of adherence varied least for an ad hoc PCI (between 17% and 20%) 25 26 and most for revascularisation in general (between 40% and 94%). 22 24 29 In these studies, the observed variation may be the result of methodological differences (eg, different data sources or different definitions of guideline adherence).…”

Section: Discussionmentioning

confidence: 99%

“…Three of the 12 studies included in the review assessed guideline adherence for the invasive diagnostic CA, [19][20][21] while nine did so for therapeutic revascularisation by means of a PCI/percutaneous transluminal coronary angioplasty (PTCA) and/or CABG. [22][23][24][25][26][27][28][29][30] With one exception, all the studies were either based on a retrospective cross-sectional design (n=7) 21 22 25-27 29 30 or a prospective cohort design (n=4). 19 20 24 28 The studies evaluated both primary and specialised care (eg, catheterisation laboratory) over study periods ranging from 5 months 19 to 5 years 27 from 1991 22 23 to 2020.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

et al. 2023

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ObjectivesIn the care of coronary artery disease (CAD), evidence questions the adequate application of guidelines for cardiovascular procedures, particularly coronary angiographies (CA) and myocardial revascularisation. This review aims to examine how care providers’ guideline adherence for CA and myocardial revascularisation in the care of chronic CAD was assessed in the literature.DesignScoping review.Data sourcesPubMed and EMBASE were searched through in June 2021 (rerun in September 2022).Eligibility criteriaWe included studies assessing care providers’ adherence to evidence-based guidelines for CA or myocardial revascularisation in the care of chronic CAD. Studies had to list the evaluation of guideline adherence as study objective, describe the evaluation methods used and report the underlying guidelines and recommendations.Data extraction and synthesisTwo independent reviewers used standardised forms to extract study characteristics, methodological aspects such as data sources and variables, definitions of guideline adherence and quantification methods and the extent of guideline adherence. To elucidate the measurement of guideline adherence, the main steps were described.ResultsTwelve studies (311 869 participants) were included, which evaluated guideline adherence by (1) defining guideline adherence, (2) specifying the study population, (3) assigning (classes of) recommendations and (4) quantifying adherence. Thereby, primarily secondary data were used. Studies differed in their definitions of guideline adherence, where six studies each considered only recommendation class I/grade A/strong recommendations as adherent or additionally recommendation classes IIa/IIb. Furthermore, some of the studies reported a priori definitions and allocation rules for the assignment of recommendation classes. Guideline adherence results ranged from 10% for percutaneous coronary intervention with prior heart team discussion to 98% for coronary artery bypass grafting.ConclusionDue to remarkable inconsistencies in the assessment, a cautious interpretation of the guideline adherence results is required. Future efforts should endeavour to establish a consistent understanding of the concept of guideline adherence.

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