Enhancing the quality of care for patients with coronary heart disease: the design and baseline results of the hastening the effective application of research through technology (HEART) trial

Am J Manag Care. 2002 Dec;8(12):1069-78.


Background: Effective therapies exist for reducing mortality in persons with coronary heart disease (CHD), but they remain underused.

Objective: To report the design and baseline results of a quality improvement project designed to increase the use of hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, beta-adrenergic blocking agents, and angiotensin-converting enzyme (ACE) inhibitors in patients with CHD in a network-model managed care setting.

Methods: Patients with CHD were identified by searching a claims database. Use of therapies was assessed by linkage with a pharmacy benefits database. A survey was mailed to primary care physicians to collect information related to attitudes and behavioral intentions regarding aggressive management of CHD. An intervention, consisting of a guideline summary, performance feedback, and medical chart reminders, was evaluated in a randomized, practice-based trial.

Results: Among 1189 patients with CHD, the median prevalence of receipt of HMG-CoA reductase inhibitors, beta-adrenergic blocking agents, and ACE inhibitors across practices at baseline (the first 3 months of 1999) was 50.0%, 35.0%, and 18.8%, respectively. Reported barriers included a perception that aggressive management of CHD is thought to be unimportant by support staff yet to require significant staff time. Aggressive management of CHD was perceived to incur non-reimbursable costs, to be unimportant in their patient population, to require a great deal of patient education and self-management, and to be limited because many patients do not adhere to therapy.

Conclusions: Opportunities exist for enhancing the quality of care provided to patients with CHD. Our experience to date supports the logistical feasibility of implementing network-level quality enhancement efforts in managed care networks.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Community Networks / organization & administration
  • Community Networks / standards
  • Coronary Artery Disease / drug therapy*
  • Drug Utilization*
  • Female
  • Health Services Research
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Managed Care Programs / organization & administration
  • Managed Care Programs / standards*
  • Middle Aged
  • North Carolina
  • Practice Patterns, Physicians'*
  • Primary Health Care / organization & administration
  • Primary Health Care / standards*
  • Quality Assurance, Health Care*


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors