The American Heart Association get with the guidelines program

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Abstract

Get With The Guidelines (GWTG) is a hospital-based quality improvement initiative created by the American Heart Association (AHA) and the American Stroke Association (ASA) to improve the care of patients with cardiac diseases and stroke. It supports the AHA mission to reduce death and disability due to cardiovascular diseases and stroke. It is evidence-based and founded on the American College of Cardiology/American Heart Association Guidelines for secondary prevention of cardiovascular diseases and is designed to help health care providers consistently treat patients in accordance with these accepted guidelines.

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GTWG key components

The 10-year goal of the AHA is a 25% reduction in coronary heart disease, stroke, and risk (by 2010). The GWTG program provides health care workers with the tools, means of data collection, and information to help them implement the guidelines simply and consistently at the point of discharge.

The program centers on a Web-based system that can be accessed from any computer. Data entry takes an average of about 90 seconds and, when completed, helps the provider ensure that the patient is given

Why a hospital-based system?

When a patient is hospitalized with AMI, both the patient and the family are focused on the event and its serious nature. This focus provides a “teachable moment” for the patient and the family and can be used by the health care team to begin evidence-based care that will continue as the patient recovers and leaves the hospital. Patients who begin drug therapy at the time of hospitalization have better 6-month compliance rates than patients who are started on therapy after discharge.1

The

GWTG web tool

The GWTG Web tool is a simple interfacing tool designed to improve secondary prevention. Data entry screens in single-page, outline-format remind the physician to evaluate adherence to guidelines by checking data against AHA guidelines and querying guideline recommendations (Figure 1). The Web tool is designed to improve communication with the primary care physician (PCP) and reinforce intervention by generating a letter to the PCP documenting discharge orders. Automatic reporting to JCAHO and

Hospital recognition program

Under a GWTG recognition program, the AHA recognizes a hospital's efforts to improve the quality of patient care. There are 2 types of recognition: (1) designation as a GWTG-coronary artery disease (CAD) hospital acknowledges that the infrastructure for continuous quality improvement has been established and that system improvements are ongoing; and (2) the GWTG-CAD performance achievement award recognizes excellence and encourages improvement in performance in hospitals that have demonstrated

Recent findings from the GWTG database

A retrospective review of initial compliance data on secondary prevention before the GWTG initiative indicated good compliance rates for aspirin (77.8%), but less success with ACE inhibitors (59.3%), β-blockers (49.5%), and smoking cessation counseling (41.9%).2 Whereas intervention rates were mildly improved at 4 to 6 months after beginning GWTG tool use, by 9 to 12 months, smoking cessation, aspirin use, statin use, low-density lipoprotein (LDL) cholesterol measurement, blood pressure

Future for GTWG

One goal of the GTWG initiative is to reach and affect 75% of all AMI patients at discharge, extending improvements in guideline adherence to noncardiologists and others, such as physicians treating other cardiovascular diseases and stroke. In addition, plans to reward institutions for achieving evidence-based quality, especially for prevention, will be continued.

Conclusion

As a result of the GWTG Web tool, improvements were seen in approaches to secondary prevention, including smoking cessation, aspirin use, statin use, LDL cholesterol measurement, blood pressure control, and rehabilitation.

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