The C-QIP intervention increased prescription of all 4 recommended GDMT for atherosclerotic CVD to 73.2% vs 49.6% in usual care (RR 1.29; p=0.018).
Does a multicomponent collaborative quality improvement strategy improve implementation feasibility, acceptability, and GDMT prescription in patients with cardiovascular disease?
A multicomponent collaborative quality improvement intervention is feasible and significantly increases the prescription of evidence-based therapies for secondary prevention of cardiovascular disease in India.
Absolute Event Rate: 0% vs 0%
Abstract Background The quality of cardiovascular disease (CVD) care remains suboptimal globally, and limited evidence exists on quality improvement strategies to enhance chronic care of CVD in low resource settings. Purpose The Collaborative Quality Improvement (C-QIP) trial aimed to test the feasibility and clinical effect of a multicomponent strategy versus usual care among patients with CVD in India. Methods The C-QIP was an individual-level randomized (1:1) trial of a multicomponent intervention versus usual care implemented in four hospital-based clinics (2 public and 2 private) in India. The C-QIP intervention consisted of: 1) electronic health records and decision support system (EHR-DSS) for clinicians, 2) trained non-physician health workers, 3) text-message based lifestyle reminders, 4) patient education materials, and 5) quarterly audit and feedback reports (Figure 1). Patients with CVD attending outpatient clinics were recruited from September 2022 - 2023 and were followed for at least 12 months after randomization (Figure 2). The primary outcomes were implementation feasibility, and acceptability from patients’ and providers’ perspectives. Secondary outcomes included prescription of guideline directed medical therapy (GDMT), adherence to prescribed therapy and mean changes in CVD risk factors (the trial was no powered to show these differences). The primary analysis for clinical outcomes were conducted with the intention to treat principle. Results Of 410 participants enrolled (intervention arm=205 and usual care arm=205), mean age was 57.5 years, and 73.0% were male. Prior history of coronary heart disease was 74.6%, ischemic stroke: 18.5%, and heart failure: 18.0%.At the trial end (mean follow-up 18 months, 96.1% of participants), patients in the intervention arm were more likely to be prescribed all 4 recommended GDMT for atherosclerotic CVD (antiplatelet + lipid lowering drug + 2 anti-hypertensive drugs) 73.2% vs the usual care arm: 49.6%, difference of 15.6% (adjusted relative risk, RR: 1.29, 95% CI: 1.04 to 1.59; p=0.018), and for prescription of GDMT in patients with ischemic stroke (antiplatelet + lipid lowering drug + anti-hypertensives) was 83.0% vs 38.0% in the intervention vs usual care arms, respectively, risk difference of 43.9% (adjusted RR: 2.24, 95% CI: 1.37, 3.66); p=0.01). The intervention was not associated with significant changes in CVD risk factors. The EHR-DSS prompts acceptance by physicians of intervention arm patients for antiplatelet prompts was: 71.0%, LDLc prompts: 68.8%, blood pressure prompts: 48.4%, and glycemia prompts (among patients with diabetes) was 81.0%. Conclusion C-QIP trial demonstrated the feasibility of implementing a contextually relevant, evidence-based strategy in outpatient clinics for chronic care of CVD in India. The multicomponent, collaborative quality improvement intervention increased prescription of evidence-based therapies in patients with atherosclerotic cardiovascular disease.
Singh et al. (Sat,) reported a other. The C-QIP intervention increased prescription of all 4 recommended GDMT for atherosclerotic CVD to 73.2% vs 49.6% in usual care (RR 1.29; p=0.018).