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March 25, 2012JAMA

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

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Why the study?

Does a multifaceted quality improvement intervention improve the use of evidence-based therapies in patients with acute coronary syndromes?

Population

1,150 patients with acute coronary syndromes across 34 public hospitals in Brazil. Mean age 62, 68.6% men.

Comparison

Multifaceted quality improvement intervention… vs Routine practice (control)

Design

RCT, cluster-randomized (concealed allocation)

Follow-up

30-day

Key result

A multifaceted quality improvement intervention increased the receipt of all eligible evidence-based therapies within 24 hours compared to routine practice (67.9% vs 49.5%; OR 2.64, 95% CI 1.28-5.45).

Authors

OBOtávio BerwangerHGHélio Penna GuimarãesLLLígia Nasi Laranjeira

Discussion

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Member takes

Overview

Supports implementing multifaceted QI interventions to boost early evidence-based ACS therapy use; extends prior evidence to middle-income settings.

Study Design

Type

RCT (n=1,150)

Randomization

cluster-randomized (concealed allocation)

Multicenter

Yes

Structured PICO

Does a multifaceted quality improvement intervention improve the use of evidence-based therapies in patients with acute coronary syndromes?

P
Population
1,150 patients with acute coronary syndromes treated across 34 public hospitals in Brazil, followed for up to 30 days.
I
Intervention
Multifaceted quality improvement (QI) intervention including educational materials for clinicians, reminders, algorithms, and case manager training
C
Comparator
Routine practice (control)
O
Outcome
Percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours in patients without contraindicationscomposite

Main Result

Odds Ratio: 2.64 (95% CI 1.28–5.45)

Absolute Event Rate: 67.9% vs 49.5%

A multifaceted quality improvement intervention significantly increased adherence to evidence-based acute therapies for patients with acute coronary syndromes in a middle-income country setting.

Cite This Study

Berwanger et al. (2012) conducted an RCT in Acute coronary syndromes (ACS) (n=1,150). Multifaceted quality improvement intervention vs. Routine practice was evaluated on Percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours (OR 2.64, 95% CI 1.28-5.45). A multifaceted quality improvement intervention increased the receipt of all eligible evidence-based therapies within 24 hours compared to routine practice (67.9% vs 49.5%; OR 2.64, 95% CI 1.28-5.45).

synapsesocial.com/papers/6a6663101e18cfc7eb0ee207https://doi.org/10.1001/jama.2012.413
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