A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: Rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial

A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: Rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial

Author Berwanger, Otavio Google Scholar
Guimaraes, Helio P. Google Scholar
Laranjeira, Ligia N. Google Scholar
Cavalcanti, Alexandre B. Google Scholar
Kodama, Alessandra Google Scholar
Zazula, Ana Denise Google Scholar
Santucci, Eliana Google Scholar
Victor, Elivane Google Scholar
Flato, Uri A. Google Scholar
Tenuta, Marcos Google Scholar
Carvalho, Vitor Google Scholar
Mira, Vera Lucia Google Scholar
Pieper, Karen S. Google Scholar
Mota, Luiz Henrique Google Scholar
Peterson, Eric D. Google Scholar
Lopes, Renato Delascio Autor UNIFESP Google Scholar
Institution Res Inst HCor Hosp Coracao
Duke Univ
Universidade Federal de São Paulo (UNIFESP)
Abstract Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). the 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. the primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS. (Am Heart J 2012;163:323-329.e1.)
Language English
Sponsor Brazilian Ministry of Health
Hospital do Coracao (HCor)
Date 2012-03-01
Published in American Heart Journal. New York: Mosby-Elsevier, v. 163, n. 3, p. 323-U259, 2012.
ISSN 0002-8703 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 323-U259
Origin http://dx.doi.org/10.1016/j.ahj.2012.02.004
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000301597200006
URI http://repositorio.unifesp.br/handle/11600/34629

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