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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EOutcomes from the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes Trial [BRIDGE-ACS; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00958958\u0026amp;atom=%2Fspmdc%2F12%2F4%2F15.atom\u0022\u003ENCT00958958\u003C\/a\u003E] show that a simple, multifaceted, educational intervention can lead to significant improvements in the use of evidence-based medications in patients with acute coronary syndromes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EOutcomes from the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes Trial [BRIDGE\u2013ACS; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00958958\u0026amp;atom=%2Fspmdc%2F12%2F4%2F15.atom\u0022\u003ENCT00958958\u003C\/a\u003E] show that a simple, multifaceted, educational intervention can lead to significant improvements in the use of evidence\u2013based medications in patients with acute coronary syndromes (ACS). Otavio Berwanger, MD, PhD, Research Institute Hcor\u2013Hospital do Cora\u00e7\u00e3o, S\u00e3o Paulo, Brazil, presented results from the study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBRIDGE\u2013ACS was a cluster\u2013randomized (concealed allocation) trial that was conducted among 34 clusters (public hospitals) in Brazil. It enrolled a total of 1150 patients with ACS from March through November 2011, with follow\u2013up through January 2012. The primary endpoint was the percentage of eligible patients who received all evidence\u2013based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours [Berwanger O et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012; Berwanger O et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2012]. Secondary endpoints included adherence to all eligible evidence\u2013based therapies during the first 24 hours and the use of aspirin, beta\u2013blockers, statins, and ACE inhibitors at discharge; a composite evidence\u2013based medicine score; and major cardiovascular (CV) events. CV endpoints, including mortality, CV death, recurrent ischemic events, and bleeding, were also measured as secondary endpoints. Outcomes were reviewed by blinded outcome assessors. The analyses were performed using an intention\u2013to\u2013treat principle.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe trial included general public hospitals from major urban areas with an emergency department that treated patients with ACS. Eligible subjects were consecutive patients who met standardized definitions of ACS (STEMI, NSTEMI, and unstable angina) as soon as they presented in the emergency department. Private hospitals, cardiology institutes, and hospitals from rural areas were excluded from the study.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe quality improvement (QI) intervention included printed reminders that were attached to the clinical evaluation form; a checklist; educational materials; an algorithm for risk stratification and recommendation of evidence\u2013based therapies for each risk category; and color\u2013coded bracelets according to risk stratification category.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EClusters that were randomized to the QI program received on\u2013site training visits that were complemented by web\u2013based and telephone training. In addition, two health professionals (a physician who acted as the local leader and a research nurse case manager) attended a workshop on how to implement the QI intervention.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAmong the 80.3% of patients who were eligible for all of the study interventions, 67.9% of those in hospitals that were randomized to the QI program received all of the evidence\u2013based therapies in the first 24 hours versus 49.5% of patients who were randomized to hospitals without the QI program (p=0.01; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Similarly, use of all evidence\u2013based therapies during the first 24 hours and at discharge among eligible patients was higher in the intervention clusters versus controls (50.9% vs 31.9%; p=0.03; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Overall, composite adherence scores were higher in QI intervention clusters than in control group clusters (89% vs 81.4%; p=0.01). There was no heterogeneity in the primary endpoint among major subgroups, including institution characteristics, such as teaching versus nonteaching, PCI availability, and cardiac surgery availability.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Adherence to All Evidence\u0026#x2013;Based Therapies in the First 24 Hours.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-899094246\u0022 data-figure-caption=\u0022Adherence to All Evidence\u0026#x2013;Based Therapies in the First 24 Hours.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13998\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EAdherence to All Evidence\u2013Based Therapies in the First 24 Hours.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EZBerwanger O et al. JAMA 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Adherence to All Acute and Discharge Evidence\u0026#x2013;Based Therapies.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-899094246\u0022 data-figure-caption=\u0022Adherence to All Acute and Discharge Evidence\u0026#x2013;Based Therapies.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/4\/15\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13999\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EAdherence to All Acute and Discharge Evidence\u2013Based Therapies.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EBerwanger O et al. JAMA 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EOverall, the intervention had no significant difference on clinical outcomes. The rates of major CV events were 5.5% for patients from clusters that were randomized to the QI intervention versus 7.0% in control group clusters (p=0.35). There was a trend toward a reduced odds of myocardial infarction (OR, 0.25; 95% CI, 0.05 to 1.26; p=0.09) but an increase in major bleeding (OR, 6.88; 95% CI, 0.93 to 51.10; p=0.06) with intervention.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAccording to Dr. Berwanger, the tools that were tested in the BRIDGE\u2013ACS trial are both simple and feasible. As such, they can become the basis for developing quality improvement programs to maximize the use of evidence\u2013based interventions for the management of ACS.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/4\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznhc1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznhc1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}