Guideline assessment and implementation in congestive heart failure

In this study the feasibility of representing guidelines on the pharmacological management of heart failure was assessed using a toolbox specially designed to enter and during runtime manipulate guidelines. The toolbox distinguishes three layers to define guidelines. In the first layer, the flow charts derived from the guidelines are drawn, and annotated using natural language. Secondly, the respective rules are entered, using a domain specific vocabulary. The decision support system applies this guideline knowledge to the actual patient status and relevant laboratory results, entered by the physician or obtained from an existing data source, resulting in advice regarding this patient. In this limited study the selection and titration of three classes of drugs was modeled and for each category a prescription strategy was defined, based on severity of overfilling, co-medication and laboratory data. The decision support system selects, based on the current clinical state of the patient, the underlying pathophysiology and presence of comorbidity, the most appropriate drug strategy.