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Editorial

Guidelines in real life. Why are they not always enforced?

Department of Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal

^_* Corresponding author. Tel.: +351 239 400418; fax: +351 239 829674. (Email: antunes.cct.huc@sapo.pt).

Key Words: Guidelines • Continuing medical education • Referral for surgery

The first 20% of the full text of this article appears below.

In a paper published in this issue of the journal by Detaint et al. [1], resulting from the Euro Heart Survey on Valvular Disease, the authors analyse the outcomes of 877 patients who had isolated mitral regurgitation; 546 of whom had severe regurgitation. Of these, 101 with non-ischemic mitral regurgitation were asymptomatic. The aim of the current study was to match the decision to operate or not operate on these patients with the 1998 ACC/AHA guidelines on management of patients with heart valve disease, the only ones available at the time of the survey [2]. One third of the patients were referred to surgery. The therapeutic options were in accordance with guidelines in only 62% of the cases. Intervention had been overused in 9 patients and underused in 29, of whom 24 had a clear class I or IIa indication for surgery. The authors also found that cardiac catheterization and coronary angiography were underused. The conclusion was that guidelines are often not followed in general practice across European countries, which may have a significant impact in the late outcome of the patients.

Quality of care has been shown to correlate well with adherence to pre-established norms, of which the guidelines are one of the most significant examples, as it has also been shown in groups that participate in trials that create the evidence on which guidelines are based [3]. Hence, the importance of these rules which the most important scientific bodies that . . . [Full Text of this Article]

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				M. J. Antunes Editorial comment: Therapeutic decisions for patients with symptomatic severe aortic stenosis Much still to do! Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 958 - 959. [Full Text] [PDF]