GP's adherence to guidelines for cardiovascular disease among elderly: a quality development study.
BACKGROUND
Evidence-based guidelines should in most cases be followed also in the treatment of elderly. Older people are often suboptimally treated with the recommended drugs.


OBJECTIVE
To describe how well general practitioners adhere to current guidelines in the treatment of elderly with cardiovascular disease and evaluate local education as a tool for improvement.


METHODS
Data was collected from the medical records of patients aged ≥ 65, who visited a primary health care center in Sweden 2006 and had one or more of the following diagnoses: hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation, or prior stroke. Local education was organized and included feed-back to the patient's doctor and discussion about regional guidelines. Repeated measurements were performed in 2008.


CONCLUSIONS
The adherence to guidelines was low. Approximately one-third of the patients with hypertension reached target blood pressure, stroke patients more often. More patients with heart failure were treated with angiotensin converting enzyme inhibitor than in other European countries, but still only 60%. Half of the patients with chronic atrial fibrillation were treated with Warfarin, although more than two-thirds had a CHADS(2) score indicating the need. Educational efforts appeared to increase the adherence and hence should be encouraged.
Division of Family Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden. sara.modig@med.lu.se
Sara
S
Modig
Peter
P
Höglund
Margareta
M
Troein
Patrik
P
Midlöv
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000628:therapy*; D002908:Chronic Disease; D055317:Evidence-Based Practice; D058006:General Practice / Q000379:methods*; D058005:General Practitioners; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy; D010349:Patient Compliance; D020521:Stroke / Q000628:therapy; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin