Heart failure guidelines, performance measures, and the practice of medicine: Mind the gap

Jalal K. Ghali, Barry M. Massie, Douglas L. Mann, Michael W. Rich

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


Guidelines have rather quickly assumed a central role in health care delivery in the U.S. They have become the foundation on which performance measures are built and, therefore, a major player in assessing the quality of care provided by individuals and institutions, the ramifications of which involve reputation, reimbursement, and litigation. We are concerned, however, that in our enthusiasm for collectively endorsing these guidelines, we are marginalizing the importance of physician judgment and inadvertently risking the conversion of guidelines into "cookbooks." We believe that this viewpoint, while unequivocally acknowledging the fundamental importance of guidelines, simultaneously provides a critically important perspective on the potential for misuse of both guidelines and performance measures. Further, we hope that publication of this viewpoint will help temper enthusiasm for overzealous conversion of guidelines into performance measures, thereby restoring the vital role of physician judgment and insight into patient management.

Original languageEnglish
Pages (from-to)2077-2080
Number of pages4
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - Dec 14 2010


  • guidelines
  • performance measures
  • practice of medicine


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