Reducing the knowledge-practice gap in the management of patients with cardiovascular disease

Despite major progress in the development of effective therapy to reduce mortality and morbidity from cardiovascular disease, it remains the leading cause of mortality in this country. One aspect of this problem is represented by the lag in adoption of treatments with documented efficacy in large clinical trials. This "knowledge-practice gap" has been attributed to factors at multiple levels of the health care system that impede implementation of optimal therapy. Although there is evidence of progress in the use of recommended therapeutic modalities in the past decade, this has been modest. Recent approaches to assessment of patient care by physicians, health plans, and institutions through the tracking of clinical performance have been instituted to promote optimal patient care. They are being increasingly utilized for purposes of accreditation and will also provide guidance for consumer purchasing of health care. Such methods have the potential to promote increased adherence to current standards of care.