While multiple randomised controlled trials have outlined the optimal care for patients with acute coronary syndromes (ACS), evidence-based therapies are not always applied, particularly in low- and middle-income countries.\u00a0 In this Brazilian study, the authors hypothesised that a multifaceted quality improvement (QI) intervention could improve the use of evidence-based therapies and improve ACS outcomes.<\/p>\n
BRIDGE-ACS (Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes) was a cluster-randomised trial that enrolled a total of 1150 ACS patients between March and and November 2011.\u00a0 The multifaceted QI intervention used included reminders, a checklist, case management, and educational materials; clusters were randomly allocated to the use of these or to a routine strategy.\u00a0 The main outcome measure was the percentage of all eligible patients who received all evidence-base therapies during the first 24 hours of treatment, where no contraindications were present.<\/p>\n
40% of patients presented with ST-elevation myocardial infarction (STEMI), 35.6% with non-ST-segment myocardial infarction, and 23.6% with unstable angina.\u00a0 Almost 80% of the hospitals included were from major urban areas, and 41.2% had 24-hour PCI facilities available.\u00a0 In the intervention group, 67.9% of all eligible patients received all the appropriate acute therapies, compared to 49.5% in the control group.\u00a0 This also translated into an increased likelihood of receiving appropriate discharge medications (51.0% vs. 31.9%).\u00a0 In-hospital cardiovascular event rates were 5.5% in the intervention group vs 7.0% in the control group, and 30-day all-cause mortality was also reduced (7.0% vs 8.4%).<\/p>\n
Conclusions<\/strong>:<\/p>\n A multifaceted educational intervention in Brazil led to a significant improvement in the use of evidence-based therapies, suggesting that this approach may improve outcomes following ACS for patients in low- and middle-income countries.<\/p>\n