European Heart Journal Advance Access published online on January 9, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi718
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1 Department of Cardiology, Room B2-240, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
* To whom correspondence should be addressed. Aims To investigate the role of guidelines in structuring the clinical care for adult patients with congenital heart disease (CHD), and to assess adherence to the guidelines in Europe. Methods and results A selected number of current guidelines were chosen pertaining to operative procedures, investigations, and the use of medication (‘interventions’). The source for this analysis was the database of the Euro Heart Survey on adult CHD, which contains retrospectively collected data on 4110 patients followed-up for a median of 5.1 years. For each guideline investigated, patients were selected from the database for whom the particular guideline was relevant. The selected cases were classified according to two criteria: was there an indication for the particular intervention and did the intervention take place? In this manner, cases of ‘undue treatment’ and ‘insufficient treatment’ were identified. Adherence to guidelines was found to be good in the case of operative procedures and prophylactic drug treatment. However, regarding diagnostic procedures there had been adherence to guidelines in only slightly more than half of the cases. Conclusion Guidelines have an important role in the actual clinical care of adults with CHD. However, large outcome studies are needed to develop more precise guidelines.
Received June 24, 2005
Revised October 26, 2005
Accepted December 8, 2005
Clinical research
Adherence to guidelines in the clinical care for adults with congenital heart disease: The Euro Heart Survey on Adult Congenital Heart Disease
Peter Engelfriet 1,
Jan Tijssen 1,
Harald Kaemmerer 2,
Michael A. Gatzoulis 3,
Eric Boersma 4,
Erwin Oechslin 5,
Erik Thaulow 6,
Jana Popelová 7,
Philip Moons 8,
Folkert Meijboom 4,
Luciano Daliento 9,
Rafael Hirsch 10,
Valérie Laforest 11,
Ulf Thilén 12,
and
Barbara Mulder 1 *
2 Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzcentrum, Munich, Germany
3 National Heart and Lung Institute, Imperial College, London, UK; Adult Congenital Heart Centre, Royal Brompton Hospital, London, UK
4 Thoraxcenter, ErasmusMC, Rotterdam, The Netherlands
5 CardioVascular Center, Division of Cardiology, University Hospital Zurich, Switzerland
6 Department of Cardiology, Rikshospitalet, Oslo, Norway
7 Department of Cardiac Surgery, Hospital Na Homolce, Prague, Czech Republic
8 Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
9 Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
10 Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
11 Euro Heart House, Sophia-Antipolis, France
12 Department of Cardiology, University Hospital, Lund, Sweden
Barbara Mulder, E-mail: b.j.mulder{at}amc.uva.nl
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