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BRIDGE-ACS: Educational intervention improved use of evidence-based medications
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CHICAGO — A multifaceted, educational intervention that implemented reminders, educational materials and checklists improved the use of evidence-based medicines by patients with acute coronary syndromes during the first 24 hours of admission to hospitals in Brazil, researchers reported.
The randomized Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) trial assessed the effectiveness of a quality improvement initiative in patients with ACS from public hospitals in Brazil. The trial was conducted among 34 public hospitals and enrolled 1,150 patients with ACS (mean age, 62 years; 69% men) from March 2011 through November 2011, with follow-up through January 2012.
Main components of the intervention included educational materials for clinicians, such as ACS guidelines, directions to a website to consult lectures about updates to ACS practice and a packet-sized copy of major ACS recommendations; reminders, checklists and case manager training. Individual hospitals selected a pair of nurses to act as case managers and follow up on patient care from admission to discharge. Researchers measured outcomes including the percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulation and statins) during the first 24 hours in patients without contraindications.
Among eligible patients (80.3%), those in hospitals that implemented the intervention were more likely to receive all eligible acute therapies within the first 24 hours compared with hospitals that did not use the intervention (67.9% vs. 49.5%). Similarly, use of all evidence-based therapies during the first 24 hours and at discharge was higher among patients at intervention hospitals vs. control hospitals (50.9% vs. 31.9%). Overall, composite adherence scores were also higher in intervention clusters than in control clusters (89% vs. 81.4%).
When the researchers examined the effect of the intervention on major clinical events at discharge, rates of major CV events were 5.5% for patients from hospitals randomized to the intervention and 7% in control hospitals; this difference was not statistically significant. Total mortality rates at 30 days were 7% for intervention hospitals vs. 8.4% from control hospitals.
“In terms of ACS, we have several studies [that] demonstrate the effectiveness of current guidelines in place at urban hospitals — the problem is that physicians do not apply these guidelines in practice. These represent important gaps in the use of evidence-based medications for patients with non–ST-segment elevation ACS, particularly in hospitals that have percutaneous coronary intervention capabilities,” Otávio Berwanger, MD, PhD, of the Research Institute HCor–Hospital do Coração, São Paulo, Brazil, said at a press conference.
The participating centers, 17 sites in the intervention group and 17 in the control group, were general tertiary care hospitals located in major urban areas. The hospitals represent a wide range of ACS care capacities, with varying protocols in place for ACS — 65% of hospitals in the study had instituted their own chest pain protocols for the ED.
“We limited our study to public hospitals because, due to Brazil’s free national health system, public hospitals serve approximately 70% of the population of approximately 200 million [people],” Berwanger said.
“Because it is simple and feasible, the tools tested in the BRIDGE-ACS trial can become the basis for developing quality improvement programs to maximize the use of evidence-based interventions for the management of ACS,” Berwanger said at the late-breaking clinical trial session. – by Bob Stott
For more information:
- Berwanger O. Late-breaking clinical trials II. Presented at: the American College of Cardiology 61st Scientific Session & Expo; March 24-27, 2012; Chicago.
- Berwanger O. JAMA. 2012;307:doi:10.1001/jama.2012.413.
Disclosure: Dr. Berwanger reports no relevant financial disclosures.