Interventions to improve adherence to clinical practice guidelines when treating cardiovascular disease: a systematic review.

Abstract

Background: Clinical practice guidelines have the potential to improve healthcare quality and safety in those with cardiovascular disease. However, guideline adherence is a challenge worldwide.

Aims: We aim to determine the types and effects of interventions that target healthcare professionals to improve adherence to cardiovascular disease treatment guidelines-specifically for atrial fibrillation, ischaemic heart disease, heart failure, dyslipidaemia, and/or hypertension in ambulatory care.

Methods: The following databases were searched from January 2012 to September 2023: MEDLINE, CINAHL, EMBASE,Cochrane, PsycINFO, ERIC International, Applied Social Sciences Index and Abstracts, clinicatrial.gov, and EUtrials. The search was supplemented by reviewing the reference lists of included studies, cited articles, and systematic reviews published in the field. Randomised trials, including cluster randomised trials and cross-over designs, were included. Two investigators independently extracted data and assessed study quality.

Results: Forty-six studies examining the impact of healthcare-targeted interventions on improving guideline adherence were identified. Various approaches were employed, with educational interventions being the most frequently used. Given the heterogeneity in types of intervention and outcomes reported in the included trials, a narrative synthesis of the data was difficult, and meta-analysis was not planned.

Conclusions: This review demonstrates that a diverse range of interventions aimed at healthcare professionals have the potential to improve adherence to CVD guidelines, but their overall effectiveness remains mixed. To narrow the gap between best practice and real-world guideline application, effective implementation strategies must become as important as guideline development itself.