Effect of a Multifaceted Intervention on Use of Evidence-Based Therapies in Patients With Acute Coronary Syndromes in Brazil

作者：Otávio Berwanger, Hélio Penna Guimarães, Lígia Nasi Laranjeira, Alexandre Biasi Cavalcanti, Alessandra A. Kodama, Ana Denise Zazula, Eliana Vieira Santucci, Elivane da Silva Victor, Marcos Tenuta, Vítor Oliveira Carvalho, Vera Lúcia Mira, Karen S. Pieper, Bernardete Weber, Luiz Henrique Mota, Eric D. Peterson, Renato D. Lópes, for the BRIDGE-ACS Investigators · 发表于：JAMA · 年份：2012 · DOI：10.1001/jama.2012.413 · 被引用次数：116 · 研究领域：Acute Myocardial Infarction Research、Health Policy Implementation Science、Cardiac Health and Mental Health

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 clu...