Improving Guideline Adherence: Randomized Trial Evaluating Strategies to Increase ß-Blocker Use in Heart Failure
{"Image DocumentName": "Improving Guideline Adherence: Randomized Trial Evaluating Strategies to Increase \u00df-Blocker Use in Heart Failure", "Image ImageDescription": "Background\u2014 The dissemination of clinical practice guidelines often has not been accompanied by desired improvements in guideline adherence. This study evaluated interventions for implementing a new practice guideline advocating the use of \u00df-blockers for heart failure patients. Methods and Results\u2014 This was a randomized controlled trial involving heart failure patients (n=169) with an ejection fraction \u226445% and no contraindications to \u00df-blockers. Patients\u2019 primary providers were randomized in a stratified design to 1 of 3 interventions: (1) control: provider education; (2) provider and patient notification: computerized provider reminders and patient letters advocating \u00df-blockers; and (3) nurse facilitator: supervised nurse to initiate and titrate \u00df-blockers. The primary outcome, the proportion of patients who were initiated or uptitrated and maintained on \u00df-blockers, analyzed by intention to treat, was achieved in 67% (36 of 54) of patients in the nurse facilitator group compared with 16% (10 of 64) in the provider/patient notification and 27% (14 of 51) in the control groups (P<0.001 for the comparisons between the nurse facilitator group and both other groups). The proportion of patients on target \u00df-blocker doses at the study end (median follow-up, 12 months) was also highest in the nurse facilitator group (43%) compared with the control (10%) and provider/patient notification groups (2%) (P<0.001). There were no differences in adverse events among groups. Conclusions\u2014 The use of a nurse facilitator was a successful approach for implementing a \u00df-blocker guideline in heart failure patients. The use of provider education, clinical reminders, and patient education was of limited value in this setting. Ansari M et al. Circulation 2003;107:2799.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}