[How to match resources with appropriateness: lessons from the registries of the Italian Association of Hospital Cardiologists].
International guidelines issued in recent years by the European Society of Cardiology and the American College of Cardiology/American Heart Association were aimed at presenting all the relevant evidence in the management of acute coronary syndromes and at helping physicians in routine clinical decision-making in order to weigh the benefits and risks of diagnostic or therapeutic procedures. A recent debate has been held in the scientific community about the correct interpretation of guidelines and the methods concerning the process of their implementation. Some of their limitations have been discussed as well. Many evidences collected in the guidelines are drawn by randomized clinical trials, some others by national and international surveys. The number of the surveys has rapidly increased in recent years, in both the international (ENACT, GRACE, Euro Heart Survey ACS, NRMI) and the Italian setting; some of these have been organized by the Italian Association of Hospital Cardiologists (ANMCO), either as national surveys (BLITZ-1 and BLITZ-2) or as regional or local registries (AI-CARE2, VENERE, GestIMA). In these reports a gap between the evidence-based recommendations of guidelines for acute coronary syndromes and actual clinical practice was documented. The lack of compliance with guidelines appears to be prevalent across a variety of medical conditions. The reluctance of physicians to apply the guidelines regarding the performance of an early invasive strategy, or the administration of glycoprotein IIb/IIIa inhibitors or thienopyridines is sometimes due to concerns that guidelines may not be valid in certain subsets of high-risk patients encountered in daily clinical practice or to inadequacy in the way care for acute coronary syndromes is delivered. Observational studies attempt to understand how clinical practice may be modified through continuous feedback. ANMCO, like other associations of cardiologists, is focusing its efforts on the improvement of the quality of care for acute coronary syndromes through educational interventions that target cardiologists involved in the care of patients, and on the improvement of the appropriate use of invasive cardiac procedures and other guideline recommendations mainly in high-risk patients.
Oltrona
Luigi
L
Dipartimento CardioToracoVascolare A De Gasperis, Ospedale Niguarda Ca' Granda, Milano. loltrona@tiscali.it
Pirola
Roberto
R
Mafrici
Antonio
A
Klugmann
Silvio
S
D000208:Acute Disease; D000789:Angina, Unstable / Q000175:diagnosis / Q000628:therapy; D002309:Cardiology / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012307:Risk Factors; D013577:Syndrome