Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme E uropean QU ality I mprovement P rogramme for A cute C oronary S yndrome: The EQUIP-ACS project protocol and design

Estimated 2,000-4,000 patients with non-ST elevation acute coronary syndromes (NSTEMI or unstable angina) aged ≤80 years, admitted to 38 hospitals across 5 European countries. Key inclusion: good clinical history of ACS with new/transient ST/T wave changes or elevated cardiac markers. Key exclusion: persistent ST elevation, use of early reperfusion therapy, age >80 years, transferred from another hospital.

High-intensity quality improvement (QI) programme for hospital staff, including the formation of a multidisciplinary team, weekly meetings, and 3 detailed QI training sessions over a 3-month period.

Low-intensity quality improvement programme (control group) consisting of full training on the study protocol and database, access to online performance reports, and regular telephone contact.

Composite of eight measures to assess aggregate potential for improvement in the management and treatment of non-ST elevation ACS (risk stratification within 24 hours, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose, and clopidogrel at discharge).composite