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.
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.
authors.affiliation: Research Institute Hcor-Hospital do Coração, São Paulo, Brazil. oberwanger@hcor.com.br
authors.forename: Otávio
authors.initials: O
authors.lastname: Berwanger
authors.forename: Hélio P
authors.initials: HP
authors.lastname: Guimarães
authors.forename: Ligia N
authors.initials: LN
authors.lastname: Laranjeira
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Cavalcanti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Kodama
authors.forename: Ana Denise
authors.initials: AD
authors.lastname: Zazula
authors.forename: Eliana
authors.initials: E
authors.lastname: Santucci
authors.forename: Elivane
authors.initials: E
authors.lastname: Victor
authors.forename: Uri A
authors.initials: UA
authors.lastname: Flato
authors.forename: Marcos
authors.initials: M
authors.lastname: Tenuta
authors.forename: Vitor
authors.initials: V
authors.lastname: Carvalho
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Mira
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Mota
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D001938:Brazil; D019468:Disease Management; D004311:Double-Blind Method; D019317:Evidence-Based Medicine / Q000379:methods*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D058996:Quality Improvement / Q000458:organization & administration*