Improving Adherence to Guidelines for Acute Stroke Management

In recent years, many medical professional organizations such as the European Society of Cardiology, the American Heart Association, the American College of Cardiology, and the American Stroke Association have promoted guideline-based therapy for different groups of patients. These guidelines are based in part on large clinical trials and, when such are not available, on so-called expert opinion.Article p 107 Some argue that pursuing adherence to guidelines is a worthy effort by itself, just to bring order into diversity. For others, it seems obvious that use of guidelines leads to improved quality of medical care and improved health outcomes. Yet a few wonder whether the chain of evidence from guideline development and implementation, adherence to guidelines, and improved process of care through improved quality and functional outcomes is everywhere as solid as it should be.It has become quite clear that in order to improve healthcare quality, merely introducing guidelines is not sufficient, not even after creating a solid framework of evidence-based recommendations. The guidelines should be incorporated in a quality-assurance cycle with education programs and feedback from registries or surveys of clinical practice (Figure 1), such as the Get with the Guidelines program (GWTG). Figure 1. The quality assurance cycle: relationship between guideline development, education programs, and feedback from registries or surveys of clinical practice.Several large surveys in Europe and the United States have indicated that adherence to guidelines for the clinical management of stroke and cardiovascular disease needs improvement.1,2 For example, treatment with oral anticoagulants to prevent recurrent stroke in patients with symptomatic atrial fibrillation has been recommended in clinical guidelines for more than a decade. Undertreatment is associated with an increased stroke rate.3 Treatment with anticoagulants should be tailored to estimated stroke risk, yet in the EuroHeartSurvey program several other factors were associated with …