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Title: 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
Authors: Berwanger, Otavio
Guimaraes, Helio P.
Laranjeira, Ligia N.
Cavalcanti, Alexandre B.
Kodama, Alessandra
Zazula, Ana Denise
Santucci, Eliana
Victor, Elivane
Flato, Uri A.
Tenuta, Marcos
Carvalho, Vitor
Mira, Vera Lucia
Pieper, Karen S.
Mota, Luiz Henrique
Peterson, Eric D.
Lopes, Renato Delascio [UNIFESP]
Res Inst HCor Hosp Coracao
Duke Univ
Universidade Federal de São Paulo (UNIFESP)
Issue Date: 1-Mar-2012
Publisher: Elsevier B.V.
Citation: American Heart Journal. New York: Mosby-Elsevier, v. 163, n. 3, p. 323-U259, 2012.
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.)
ISSN: 0002-8703
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