Cardiovascular disease continues to be the leading cause of mortality and morbidity in the United States. To assist health care practitioners in their integration of new information into clinical practice, professional organizations such as the American Heart Association, American College of Cardiology, and Heart Failure Society of America have developed clinical practice guidelines to promote evidence-based standards of care in the management of cardiovascular disease. Despite the comprehensive nature and widespread dissemination of these guidelines, target parameters are not being achieved, and many patients are not managed optimally. Areas of suboptimal care include failure to achieve lipid and blood pressure goals, underprescribing of antiplatelet or anticoagulant therapy in patients with coronary artery disease and atrial fibrillation, beta-blockers in patients post myocardial infarction, and beta-blockers and angiotensin converting enzyme inhibitors in patients with systolic left ventricular dysfunction. In addition to being underutilized, even when beta-blockers and angiotensin converting enzyme inhibitors are prescribed they are prescribed at doses below those proven to be of benefit in the randomized clinical trials that demonstrated their significant effect on reducing morbidity and mortality. The failure of implementation of optimal evidence-based guideline care has been attributed to a number of reasons including lack of knowledge of the guidelines and the failure of the guidelines to instruct the health care provider on strategies to implement the guidelines in individual patients. To facilitate the incorporation of these treatment guidelines into everyday medical practice, the Cardiac Goal Program software was developed to prompt entry of data essential to the management of cardiovascular disease, based on Class I or Grade A recommendations using established guidelines, into standardized, computerized forms with a reminder system. The primary aims of this proposal are 1) to incorporate beta-blocker and angiotensin converting enzyme inhibitor treatment algorithms into our existing Cardiac Goal Program and 2) employ usability methodologies, including in-depth interviews and focus groups with physicians, nurses, and physician assistants, to further refine the software based on the feedback obtained. If this decision support system is successful and widely implemented, the best outcomes from care for chronic heart failure may be achieved.
