Get With The Guidelines Health Equity Research

Below is a complied list of published documents related to the American Heart Association's Get With the Guidelines and the program's impact on equitable care. For more information on the impact of collecting health equity data through Get With The Guidelines, visit Get With The Guidelines Health Equity Data.

1. Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke. Sheriff F, Xu H, Maud A, Gupta V, Vellipuram A, Fonarow G, Matsouaka R, Xian Y, Reeves M, Smith E, Saver J, Rodriguez G, Cruz-Flores S, Schwamm L. Journal of the American Heart Association. 2022;11:e023212. https://doi.org/10.1161/JAHA.121.023212. 
   Despite slightly better short‐term outcomes among under‐represented racial and ethnic groups including Black, Hispanic, and Asian compared with NHW patients, these improvements were not sustained at 3 months. We demonstrated in this large GWTG cohort that despite overall improvement in EVT use across racial and ethnic groups post‐2015 likely corresponding to publication of groundbreaking trials and subsequent guidelines, differences still exist according to race and ethnicity, with Non‐Hispanic Black patients having lower rates of EVT use than NHW patients. These differences have narrowed over time. 
   
   
2. Association of Race and Ethnicity and Ethnicity with Oral Anticoagulation and associated outcomes in patients with atrial fibrillation: Findings from GWTG-Atrial Fibrillation Registry. Essien U, Chiswell K, Kaltenbach L. JAMA Cardiology.2022;7(12):1207-1217. doi:10.1001/jamacardio.2022.3704 2022.

   In a national registry of hospitalized patients with AF, compared with white patients, Black patients were less likely to be discharged while taking anticoagulant therapy and DOACs in particular. Black and Hispanic patients had higher risk of stroke compared with white patients; Black patients had a higher risk of bleeding and mortality. There is an urgent need for interventions to achieve pharmacoequity in guideline-directed AF management to improve overall outcomes.
   
   

3. Regional Variations in Heart Failure Quality and Outcomes: Get With The Guidelines-Heart Failure Registry. Cunningham LC, Fonarow GC, Yancy CW, Sheng S, Matsouaka RA, DeVore AD, Jneid H, Deswal A. Journal of the American Heart Association. 2021;10:e018696

   Regional variations in patient demographics, quality of HF care, and short-term outcomes in patients hospitalized with HF were examined. The differences in quality of in-hospital care were small and did not vary substantially or systematically by geographic region. Findings suggest that in the context of hospitals participating in a national HF quality improvement program, overall similar in-hospital quality of care can be achieved irrespective of region.
   
   

4. Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke. Mendelson S, Zhang S, Matsouaka R, Xian Y, Shah S, Lytle BL, Solomon N, Schwamm L, Smith EE, Saver JL, Fonarow G, Holl J, Prabhakaran S. Neurology. 2022 Apr 19;98(16):e1596-e1604. doi:10.1212/WNL.0000000000200138.

   Study sought to determine the prevalence of tPA declination using Get With The Guidelines®-Stroke in AIS patients eligible for tPA admitted to participating hospitals between 1/1/16 and 3/28/19. The overall rate of tPA decline was low, but eligible non-Hispanic Black patients were more likely and Asian patients less likely to decline tPA than non-Hispanic white patients. Reducing rates of tPA declinations among non-Hispanic Black patients may be an opportunity to address disparities in stroke care.
   
   

5. Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation Among Patients Hospitalized With Heart Failure. Thomas K, Piccini J, Liang L, Fonarow G, Yancy C, Peterson E, Hernandez A. Journal of the American Heart Association. 2013;2:e000200. https://doi.org/10.1161/JAHA.113.000200.

   Black patients hospitalized for HF have many risk factors for atrial fibrillation, but a lower prevalence of it than white HF patients. Overall, guideline-recommended warfarin for patients with AF remains inadequate, and Black patients at significant thromboembolic risk were less often prescribed warfarin at discharge than were white patients. Future studies should continue to explore explanations for the lower prevalence of AF in Black patients and examine policies that can both increase oral anticoagulation for all indicated patients and eliminate racial disparities in anticoagulation use.
   
   

6. Use of Hydralazine-Isosorbide Dinitrate Combination in African American and Other Race/Ethnic Group Patients With Heart Failure and Reduced Left Ventricular Ejection Fraction. Golwala H, Thadani U, Liang L, Stavrakis S, Butler J, Yancy C, Bhatt D, Hernandez A, Fonarow G. Journal of the American Heart Association. 2013;2:e000214. 10.1161/JAHA.113.000214

   Black patients with systolic heart failure may not be getting the recommended drug therapy for their condition. The study finds that the implementation of best evidence-based guideline driven therapies remains unacceptably slow in clinical practice, especially in the treatment of HF patients with a strong indication for the combination of isosorbide dinitrate and hydralazine. Disparate care remains a major impediment in the full implementation of best quality of care; these data demonstrate that a reasonable strategy to improve adherence to guideline-directed medical therapy is through a dedicated process of care improvement program as represented by Get With the Guidelines®-HF.
   
   

7. Trends in Use of Implantable Cardioverter Defibrillator Therapy Among Patients Hospitalized for Heart Failure: Have the Previously Observed Sex and Racial Disparities Improved Over Time? Al-Khatib S, Hellkamp A, Hernandez A, Fonarow G, Thomas K, Al-Khalidi H, Heidenreich P, Hammill S, Yancy C, Peterson E. Circulation. 2012;125:1094–1101

   In the Get With the Guidelines®-HF quality improvement program, a significant increase in ICD therapy use was observed over time in all sex and race groups. The previously described racial disparities in ICD use were no longer present by the end of the study period; however, sex differences persisted.
   
   

8. Association of Race/Ethnicity with Clinical Risk Factors, Quality of Care, and Acute Outcomes in Patients Hospitalized with Heart Failure. Thomas K, Hernandez A, Dai D, Heidenreich P, Fonarow G, Peterson E, Yancy C.American Heart Journal. 2011. https://doi.org/10.1016/j.ahj.2011.01.012

   Hispanic and Black patients hospitalized with heart failure have more cardiovascular risk factors, such as diabetes and high blood pressure, and tend to be younger than white patients hospitalized with heart failure. Within the context of a national heart failure quality improvement program, heart failure care was equitable among Get With the Guidelines®-Heart Failure hospitals and improved in all racial/ethnic groups over time.
   
   

9. Racial and Ethnic Differences in the Treatment of Acute Myocardial Infarction: Findings from the Get With The Guidelines- CAD program.Cohen M, Fonarow G, Peterson E, Moscucci M, Dai D, Hernandez A, Bonow R, Smith S. Circulation. 2010;121:2294–2301

   Hospitals using the American Heart Association’s Get With The Guidelines®- CAD program improved their evidence-based treatment for heart attack patients, eliminated racial and ethnic disparities in care, and increased overall use of evidence-based care for heart attack patients.

   Editorial: Disparities in Cardiovascular Care. Does a Rising Tide Lift All Boats? Nakela L. Cook. Circulation. 2010;121:2253–2254
   
   

10. Race and Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke. Schwamm L, Reeves M, Pan W, Smith E, Frankel M, Olson D, Zhao X, Peterson E, Fonarow G. Circulation. 2010;121:1492-150
    Black patients with stroke received fewer evidence-based care processes than Hispanic or white patients. These differences could lead to increased risk of recurrent stroke. Quality of care improved substantially in the Get With The Guidelines®-Stroke Program over time for all 3 racial/ethnic groups