Education intervention improves use of evidence-based ACS therapy
MedWire News: Researchers have shown that a multifaceted education intervention can significantly improve use of evidence-based therapies in Brazilian patients with acute coronary syndrome (ACS).
"Because this intervention is relatively simple and feasible, the approaches tested in [this] trial can become the basis for developing quality improvement (QI) programs to maximize the use of evidence-based interventions for the management of ACS," say Otávio Berwanger (Research Institute Hcor-Hospital do Coraç?o, S?o Paolo, Brazil) and team.
The Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) is a cluster-randomized trial that was published in the Journal of the American Medical Association to coincide with the American College of Cardiology's 61st Annual Scientific Sessions in Chicago.
It included 34 clusters of public hospitals in Brazil and enrolled a total of 1150 ACS patients from March 2011 through November 2011, with follow-up through January 2012.
Overall, 17 hospitals were allocated to the QI intervention and received educational materials such as pocket guidelines, an interactive website containing presentations about ACS, and instructional videos on how to implement the QI intervention. They also received posters containing evidence-based recommendations for ACS management to be displayed in the emergency department, coronary care unit, and clinical wards.
The 17 hospitals allocated to the control group continued with their usual clinical practice.
The primary endpoint of the study was the percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours without contraindications.
Overall, 67.9% of the 923 eligible patients in the intervention group versus 49.5% of the 1150 in the control group received all eligible acute therapies.
Similarly, 801 eligible patients in the intervention group were significantly more likely to receive all eligible acute and discharge medications than the 1150 in the control group (50.9 vs 31.9%).
Overall composite adherence scores were higher in the intervention clusters than in the control group, at 89% versus 81.4%.
In-hospital cardiovascular event rates and 30-day all-cause mortality were significantly lower in the intervention versus control groups, at 5.5% vs 7.0% and 7.0% vs 8.4%, respectively.
"Large-scale international cluster-randomized trials with adequate power are warranted to assess the effect of QI interventions on clinical outcomes as well as on cost-effectiveness," conclude the authors.
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By Piriya Mahendra