Use of clinical practice guidelines in congestive heart failure

Abstract

In recent years, many peer review organizations have developed clinical practice guidelines in an attempt to provide the most cost-effective care for patients. Two practice guidelines now exist for patients with congestive heart failure: one published by the Agency for Health Care Policy and Research and the other published by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. The purpose of this review is to summarize and compare both of these guidelines and to evaluate their usefulness in the care of individual patients. The format of this review provides a guide on how to evaluate new clinical practice guidelines, as well as providing a concise summary (using a clinical algorithm and several tables) that can be used as part of an institution's guideline reminder system or clinical pathway. Although the guidelines come from different sources, they are heavily based on the current medical literature and evidence. The Agency for Health Care Policy and Research guideline on Heart Failure Evaluation and Treatment is driven primarily by a clinical algorithm. The medical literature is graded on the level of evidence, and the strength of recommendations is weighted. The American College of Cardiology/American Heart Association guideline on Heart Failure covers a broader group of patients including those in cardiogenic shock, pediatric heart failure patients, and those with diastolic dysfunction. The guideline does not use a clinical algorithm but contains graded indications for a variety of clinical evaluations and treatments that should be useful in patients presenting with heart failure.