Implementing the GWTG-CAD Program in Mexico: Feasibility, Challenges and Lessons Learned for Acute and Secondary...

The American Heart Association's GWTG (Get With The Guidelines) program has demonstrated effectiveness in standardizing and improving cardiovascular care in the United States. This study describes the implementation of the GWTG-CAD (GWTG-Coronary Artery Disease) program in Mexico and evaluates its impact on adherence to guideline-directed medical therapy and key clinical processes.

Patients presenting with acute coronary syndrome from 10 hospitals in Mexico were included in the GWTG-CAD registry. Clinical processes and guideline-directed medical therapy use were assessed over the program's first 18 months, grouped into preprogram, 0 to 6 months, 6 to 12 months, and 12 to 18 months.

A total of 2363 patients were analyzed. Mean age was 62.7±12.4 years, and 73.4% were male. ST-segment-elevation myocardial infarction was the initial presentation in 65.4% (n=1546). Substantial improvements were achieved in time-sensitive care. The proportion of patients receiving an ECG within 10 minutes of arrival increased from 61% preprogram to 93% at 12to 18 months (P<0.001), and mean time to first ECG decreased from 23.3±38.7 minutes to 8.5±19 minutes (P<0.001). Guideline-directed medical therapy at discharge (aspirin, beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet agents) remained consistently >85%. Significant improvements were observed on health processes, including ECG documentation (89%-97.3%), symptom onset recording (79.7%-90.1%), left ventricular ejection fraction assessment (73.4%-87.5%), and lipid profile measurement (42.7%-72%) (all P<0.001).

Implementation of the GWTG-CAD program in Mexico enabled the identification of critical barriers in cardiac care and supported targeted quality-improvement strategies, resulting in measurable improvements in clinical processes over 18 months.