Predictors of Physician Compliance With American Heart Association Guidelines for Acute Myocardial Infarction

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Abstract
Strong evidence exists for American Heart Association guidelines for treatment of acute myocardial infarction, yet therapies are widely underutilized. Nurses are key players in leading uptake of these guidelines in clinical practice. To understand factors impacting guideline compliance, Ajzen's theory of planned behavior was used to explain the influence of beliefs, attitude, subjective norms, and perceived personal behavioral control on utilization behavior. Acute myocardial infarction database records were reviewed. An 11-question survey was created and sent to 45 physicians. The survey measured perceptions of public reporting, report cards, tools (order sets, pocket guides), and perceptions of their own compliance. Physician perceptions, specialty, patient variables age, gender, angiogram performance, and mortality were compared with guideline compliance (meeting ≥3 indicators). Ten hypotheses were tested. Results showed a correlation between guideline compliance and physician perception of report cards, as well as perception of their own performance. Interventional cardiologists were more compliant than noninterventional cardiologists or hospitalists/intensivists. Patient but not physician age mattered. Angiogram correlated with compliance; noncompliant physician group mortality was higher. The attitude construct of Ajzen's theory correlated most with compliant behavior. The American Heart Association guidelines impact mortality. Physicians view order sets and pocket guides positively. Compliance differs by specialty, providing opportunities for education.