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

Abstract

pecially acute coronary syndromes (ACS), are the leading cause of morbidity and mortality globally. 1,2 Large-scale randomized trials have established the efficacy of several interventions for the care of patients with ACS, including antiplatelet therapy, anticoagulation, reperfusion for patients with STsegment elevation myocardial infarction (STEMI), and secondary prevention with aspirin, ␤-blockers, statins, and angiotensin-converting enzyme inhibitors. 3-8 Nevertheless, registries have consistently demonstrated that the translation of research findings into practice is suboptimal 9-11 and that these care gaps are even greater in low-and middle-income countries. 12-15 Changing clinical behavior to improve quality of care is challenging. Prior systematic reviews have suggested that certain quality improvement (QI) tools are associated with better quality of care. 16 These include reminders, educational outreach visits, audit and feedback, case management, and distribution of edu-Author Affiliations and the BRIDGE-ACS Investigators are listed at the end of this article.

Effect of a Computer-Guided, Quality Improvement Program for Cardiovascular Disease Risk Management in Primary Health Care

“…Given the particularly large unmet need for quality improvement interventions in low-and middle-income countries, such regions should also be a major focus for attention. 30 The strengths of this study include the pragmatic implementation of a randomized study within usual day-to-day practice, the large sample size, the clinical outcome data, scalable intervention components, and the low level of implementation support required. Another strength is the representativeness of participating general practices and ACCHSs.…”

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

“…Except for P2Y12 inhibitors, all recommended medications are available in all emergency care facilities and general hospitals in Salvador. Accordingly, the BRIDGE‐ACS (Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes)23 randomized trial demonstrated the impact of a multifaceted educational intervention leading to a significant increase in the use of evidence‐based therapies in patients with acute coronary syndromes in public hospitals in Brazil, which highlights another opportunity to improve care.…”

Cardiovascular Health in Brazil

“…49 A recently published cluster-randomized clinical trial showed that quality improvements tools for acute coronary syndrome implemented in Brazilian public hospitals resulted in significant improvement of in-hospital cardiovascular event rates and 30-day all-cause mortality. 52 Myocardial infarction and stroke have recently received special attention by the Health Ministry with the aim of improving the organization of regionalized systems of care for both conditions. [53][54][55] New procedures and drugs were made reimbursable by the SUS, and financial incentives were given to create regionalized networks.…”