The therapeutic gap - compliance with medication and guidelines

Hospitals, clinics and cardiologists have a significant impact on prescribing in general practice. Physicians in primary care rank hospital recommendations as one of the most important sources of information on new drugs. However, recent surveys of coronary heart disease (CHD) prevention paint a depressing picture about the current evidence-based management of risk factors, such as hypercholesterolaemia and hypertension, in both secondary- and primary-care settings. European guidelines have identified secondary prevention as the top priority in patients with established CHD and lowered cholesterol thresholds in light of evidence, not only from the 4S study, but also from the CARE and LIPID studies, which highlighted the risks posed by even normal or moderately elevated cholesterol levels. There is a clear need for those involved in duality assurance in hospital care to take ownership of such guidelines. Cardiologists can play a key role - they do not face the problem alone, but evidence suggests that they can have a significant positive impact on the management of CHD risk factors in primary care. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.