Acute Coronary Syndromes
Conditions
Keywords
myocardial infarction, knowledge transfer, acute coronary syndromes
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.
Interventions
BEHAVIORALknowledge translation
knowledge translation that include: Community of practice, local gap analysis, opinion leaders, targeted interventions, performance feedback, reminders and local formation of ACS teams.
Sponsors
Sanofi
Canadian Institutes of Health Research (CIHR)
Fonds de la Recherche en Santé du Québec
Montreal General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Had a final discharge diagnosis of one of the following categories: 1. Myocardial infarction with ST-segment elevation 2. Myocardial infarction without ST-segment elevation 3. Unstable angina 4. Acute coronary syndromes -
Exclusion criteria
1. Non-atherosclerotic coronary artery disease (as confirmed by coronary angiograms or other non-invasive tests such as stress test, coronary CT-scan, nuclear scans) 2. Hospital stay of less than 48 hours -
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients who received evidence-based medical therapy at hospital discharge (mean of 4 days) | at hospital discharge (average of 4 days) | Evidence-based medical therapy is defined as aspirin,dual-antiplaquelets, beta-blockers, statins. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Discharge prescription of individual evidence-based medical therapy: aspirin, dual antiplatelets, beta-blockers | at hospital discharge (average of 4 days) | For each of the following medication: aspirin, dual anti-platelet, beta-blocker and statin, we calculated the proportion of patients who were prescribed the specific medication at discharge (as recorded on the discharge prescription). |
| Safety endpoints (mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds)) | in-hospital (average of 4 days) | mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds) |
Outcome results
None listed