Knowledge Translation to Promote Evidence-based Medical Therapy in Acute Coronary Syndromes
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Acute Coronary Syndromes
- Sponsor
- Montreal General Hospital
- Enrollment
- 4604
- Primary Endpoint
- Proportion of patients who received evidence-based medical therapy at hospital discharge (mean of 4 days)
- Status
- Completed
- Last Updated
- 10 years ago
Overview
Brief Summary
Cluster randomized open-label experimental study multi-center of 24 hospitals to either knowledge translation vs usual care to improve care of patents hospitalized for acute coronary syndromes.
Detailed Description
The AMI-OPTIMA study was a cluster randomized controlled trial of 24 hospitals to one-year knowledge translation (KT) vs usual care. Prior to randomization, we reviewed charts of 100 consecutive acute coronary syndromes (ACS) patients at each participating hospital in 2009. During one year, hospitals randomized to KT completed: 1) revision of the most recent American Heart Association Guidelines of ACS management, 2) focus groups to identify and solve local care gaps, and 3)local champion team to promote evidence-based medical therapy (EBMT). At the end of 12-month of KT/usual care, we reviewed discharge prescriptions of 100 consecutive ACS patients at each participating hospital (year 2012). EBMT was pre-defined as in-hospital anticoagulation and discharge prescription of dual anti-platelets, beta-blockers, statins, and angiotensin pathway modulating agents (for patients with impaired left ventricular systolic function). Refusal, impaired cognitive function, allergy or intolerance of patients to any of EBMT were considered valid reasons for withholding EBMT.
Investigators
Thao Huynh
Cardiologist, associate professor of medicine
Montreal General Hospital
Eligibility Criteria
Inclusion Criteria
- •Had a final discharge diagnosis of one of the following categories:
- •Myocardial infarction with ST-segment elevation
- •Myocardial infarction without ST-segment elevation
- •Unstable angina
- •Acute coronary syndromes -
Exclusion Criteria
- •Non-atherosclerotic coronary artery disease (as confirmed by coronary angiograms or other non-invasive tests such as stress test, coronary CT-scan, nuclear scans)
- •Hospital stay of less than 48 hours -
Outcomes
Primary Outcomes
Proportion of patients who received evidence-based medical therapy at hospital discharge (mean of 4 days)
Time Frame: at hospital discharge (average of 4 days)
Evidence-based medical therapy is defined as aspirin,dual-antiplaquelets, beta-blockers, statins.
Secondary Outcomes
- Discharge prescription of individual evidence-based medical therapy: aspirin, dual antiplatelets, beta-blockers(at hospital discharge (average of 4 days))
- Safety endpoints (mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds))(in-hospital (average of 4 days))