Monday, November 10, 2008

Parsing Heart Failure Treatment Guidelines

Want to know how to treat heart failure? It seems there are plenty of subspecialty groups within our specialty eager to offer guidelines on the proper management of various aspects of heart failure. Consider recommendations for treating heart failure from:
Can you venture any guess why so many organizations want to make sure we know how to treat heart failure? I wonder what it costs to create all these specialty societies and who funds their existence. Do all funds come from their members? Or might the pharmaceutical and device industries be supporting a significant portion of one or more of these societies?


Now, let's see... which heart failure treatment guidelines should I choose?

Eenie, meenie, miney, moe....


h/t to the Natrecor rep who visited my office today.


SteveC said...

I've had CHF since 2002 and I've never heard of the Society of Chest Pain Centers. Who ARE those guys?

Bob Lipetz said...

As Executive Director of the Society of Chest Pain Centers, I am happy to relieve Dr. Fisher of any cause for suspicion of unethical motivations for the cited heart failure guidelines. Each of the organizations mentioned in the blog, serve a unique membership and it is reasonable that the guidelines are formulated to address the requirements of their specific membership's processes. In the case of the Society of Chest Pain Centers, the recommendations are for the short stay patient only. This addresses the acute phase of heart failure and not the chronic. Prior to the publication of these recommendations, there were no guidelines on these processes of any kind, particularly on the processes of outpatient observation. This work was 100% self funded. SCPC is a bridge organization between cardiology and emergency medicine, focused on improving the care of the cardiac patient. The Society of Chest Pain Centers (SCPC) is an ethical patient advocacy organization that is 100% self funded through our membership dues and services. As any of the tens of thousands of clinicians who are materially supported by these 3 professional medical organizations can attest, to imply that they exist for industry profit and not for the good of the patient is unwarranted, specious, and without merit.

DrWes said...

bob lipetz-

Thanks for your clarification. My point here was not to question the ethics of the organizations involved or to question the skills and capabilities of the individuals who develop the guidelines, but rather chose to point out that we have three organizations, each "parsing" various forms of heart failure therapy (acute vs. chronic) and utilizing significant resources to do so.

Guideline development has increasingly become a cottage industry unto itself, and carries significant costs to develop with potentially significant legal implications. The scope of recommendations between these societies are remarkable similar, and the Natrecor rep handed me YOUR guidelines, rather than those of the ACC/AHA (I, too, was unaware of your organization until then). Remarkably, Natrecor, which is made by one of the organizations listed on your website, Scios, is indicated for the "acute management" of heart failure. The rep had a nice reprint for me to view with their package info attached to the guidelines. I found it interesting that he chose those guidelines to hand me, rather than that of the MUCH larger ACC/AHA consortium of which most of us are familiar.

We also have the Heart Failure Society of America, another fine organization, but also funded by industry to some extent (heck, what professional "societies" aren't?). But with each organization producing more and more independent guidelines, and management being increasingly mandated by those guidelines (yes, don't forget those "quality measures"), you must respect that the appearance of pharmaceutical salesman whose company funds your society and has a drug specifically for the management of "acute heart failure" might color one's perspective.