ARTICLE: Therapeutic Inertia in Cardiovascular Disease Prevention

AUTHORS: Dave L. Dixon, Garima Sharma, Pratik B. Sandesara, Eugene Yang, Lynne T. Braun, George A. Mensah, Laurence S. Sperling, Prakash C. Deedwania and Salim S. Virani

JOURNAL: JACC. 2019 Oct;74(13). Doi: 10.1016/j.jacc.2019.08.014

The decline in cardiovascular (CV) mortality over the last 50 years can be largely attributed to advance in preventive care (1). Despite these improvements, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide (1). Recent advances in pharmacotherapy have led to frequent revisions of clinical practice guidelines that may further reduce CV morbidity and mortality but only if these evidence-based recommendations are widely and consistently implemented.

Clinical inertia is defined as the failure to initiate or intensify therapy when treatment goals are not met and is a well-recognized barrier to improving patient care and clinical outcomes (2). It is clear, however, that the lack of treatment intensification and goal achievement is multifactorial and includes clinician, patient, health care system, and policy/regulatory factors. Thus, we will use the term therapeutic inertia (TI), as it encompasses all of the factors that may result in inertia (2). One key contributor to TI is poor guideline implementation and slow integration of new knowledge into practice. However, even when clinicians are aware of the guidelines, there is still considerable resistance to changing previous practice habits. The pervasiveness of this problem in prevention of CV morbidity and mortality and other areas of medicine cannot be overstated.

In this perspective, we aim to highlight the significance of TI in prevention of CV morbidity and mortality, outline several strategies to reduce it, and recommend future steps.

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