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  • PMID: 22447889 was deleted because it is a duplicate of PMID: 22665103
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JAMA. 2012 May 16;307(19):2041-9. doi: 10.1001/jama.2012.413.

Effect of a multifaceted intervention on use of evidence-based therapies in patients with acute coronary syndromes in Brazil: the BRIDGE-ACS randomized trial.

Collaborators (147)

Berwanger O, Guimarães HP, Laranjeira LN, Cavalcanti AB, Kodama AA, Zazula AD, Santucci EV, Victor E, Flato UA, Tenuta M, Mira VL, Pieper KS, Mota LH, Peterson ED, Lopes RD, Berwanger O, Lopes RD, Guimarães HP, Laranjeira LN, Cavalcanti AB, de Negri A, Alves C, de Castro CM, Pieper KS, Peterson ED, Mota LH, Victor ES, Carballo MT, Pieper KS, Zazula AD, Flato UA, Tenuta M, Abreu BN, Cogni AL, Gouvea DA, de Albuquerque SE, dos Reis AC, Ramos CR, da Rocha CL, Leal FA, Rodrigues Ade A, Lima JF, Fernandes AS, de Andrade PB, de Araújo JL, Barbosa LC, dos Santos MA, Andrade AC, Kato DA, Vilanova RT, dos Santos CA, Costa GL, Silva AI, de Souza MS, da Silva AC, Martins JR, Micmacher E, de Castro RR, da Silva ME, Prioste TD, Filho RG, Gabelha E, Essinger LA, de Carvalho MD, Mantovano L, Colvero JC, de Oliveira MS, Bigolin RC, Abrantes JM, Pinheiro L, Behrensdo F, Abrantes AM, Leivas JA, Potrich JA, Rosa LC, Lemos KF, de Menezes MI, Polanczyk CA, Furtado MV, Machado DL, Grillo L, Netto GV, Fraporti C, Resende ES, de Paula Faria L, da Silva LM, Filho DC, Riva GF, Costa RM, de Miranda JR, da Silva RD, da Silva EN, Rocha MV, Frizzo A, Duarte J, Pereira C, Morinigo J, da Silva AM, Bichara A, Ferreira Mde S, Moura JL, Freitas RF, Albuquerque G, Teixeira JS, de Andrade Silva B, Bezerra HM, de Medeiros GM, Ferreira WR, Rebouças Md, Rebouças JC, de Medeiros DN, de Castro LP, Carrasco E, da Silva HM, Lucena SO, da Silva HM, Nakashima M, de Santana DM, Osório JM, Marques GU, Dantas A, Botelho AR, Reis H, Bentes R, Sousa SS, das Dores AL, Rodrigues N, Freitas KC, Correia HD, Omais AK, Ahmad H, dos Santos BE, Damin GA, Lima FA, de Medeiros Pereira PA, Trindade DG, Casseb G, Escalante J, da Silva RS, Precoma DB, Scopel GS, Cavalcante MA, Ebaid H, Vicentin P, Hernandes ME, Junior CF, Almeida VL.

Author information

  • 1Research Institute HCor--Hospital do Coração, São Paulo, Brazil. oberwanger@hcor.com.br

Abstract

CONTEXT:

Studies have found that patients with acute coronary syndromes (ACS) often do not receive evidence-based therapies in community practice. This is particularly true in low- and middle-income countries.

OBJECTIVE:

To evaluate whether a multifaceted quality improvement (QI) intervention can improve the use of evidence-based therapies and reduce the incidence of major cardiovascular events among patients with ACS in a middle-income country.

DESIGN, SETTING, AND PARTICIPANTS:

The BRIDGE-ACS (Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes) trial, a cluster-randomized (concealed allocation) trial conducted among 34 clusters (public hospitals) in Brazil and enrolling a total of 1150 patients with ACS from March 15, 2011, through November 2, 2011, with follow-up through January 27, 2012.

INTERVENTION:

Multifaceted QI intervention including educational materials for clinicians, reminders, algorithms, and case manager training, vs routine practice (control).

MAIN OUTCOME MEASURES:

Primary end point was the percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours in patients without contraindications.

RESULTS:

Mean age of the patients enrolled was 62 (SD, 13) years; 68.6% were men, and 40% presented with ST-segment elevation myocardial infarction, 35.6% with non-ST-segment elevation myocardial infarction, and 23.6% with unstable angina. The randomized clusters included 79.5% teaching hospitals, all from major urban areas and 41.2% with 24-hour percutaneous coronary intervention capabilities. Among eligible patients (923/1150 [80.3%]), 67.9% in the intervention vs 49.5% in the control group received all eligible acute therapies (population average odds ratio [OR(PA)], 2.64 [95% CI, 1.28-5.45]). Similarly, among eligible patients (801/1150 [69.7%]), those in the intervention group were more likely to receive all eligible acute and discharge medications (50.9% vs 31.9%; OR(PA),, 2.49 [95% CI, 1.08-5.74]). Overall composite adherence scores were higher in the intervention clusters (89% vs 81.4%; mean difference, 8.6% [95% CI, 2.2%-15.0%]). In-hospital cardiovascular event rates were 5.5% in the intervention group vs 7.0% in the control group (OR(PA), 0.72 [95% CI, 0.36-1.43]); 30-day all-cause mortality was 7.0% vs 8.4% (ORPA, 0.79 [95% CI, 0.46-1.34]).

CONCLUSION:

Among patients with ACS treated in Brazil, a multifaceted educational intervention resulted in significant improvement in the use of evidence-based therapies.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00958958.

Comment in

PMID:
22665103
[PubMed - indexed for MEDLINE]
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