Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .
The Enhancing Secondary Prevention in Coronary Artery Disease trial
Background : Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions , result ing in suboptimal outcomes . We evaluated whether evidence summaries , which were either unsigned or signed by local opinion leaders , improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease . Methods : We performed a r and omized trial , clustered at the level of the primary care physician , with 3 study arms : control , unsigned statements or opinion leader statements . The statements were faxed to primary care physicians of adults with coronary artery disease at the time of elective cardiac catheterization . The primary outcome was improvement in  statin management ( initiation or dose increase ) 6 months after catheterization . Results : We enrolled 480 adults from 252 practice s. Although statin use was high at baseline ( n = 316 [ 66 % ] ) , most patients were taking a low dose ( mean 32 % of the guideline -recommended dose ) , and their low-density lipoprotein ( LDL ) cholesterol levels were elevated ( mean 3.09 mmol/L ) . Six months after catheterization , statin management had improved in 79 of 157 patients ( 50 % ) in the control arm , 85 of 158 ( 54 % ) patients in the unsigned statement group ( adjusted odds ratio [ OR ] 1.18 , 95 % CI 0.71–1.94 , p = 0.52 ) and 99 of 165 ( 60 % ) patients in the opinion leader statement group ( adjusted OR 1.51 , 95 % CI 0.94–2.42 , p = 0.09 ) . The mean fasting LDL cholesterol levels after 6 months were similar in all 3 study arms : 2.35 ( st and ard deviation [ SD ] 0.86 ) mmol/L in the control arm compared with 2.24 ( SD 0.73 ) among those in the opinion leader group ( p = 0.48 ) and 2.19 ( SD 0.68 ) in the unsigned statement group ( p = 0.32 ) . Interpretation : Faxed evidence reminders for primary care physicians , even when endorsed by local opinion leaders , were insufficient to optimize the quality of care for adults with coronary artery disease . Clinical Trials.gov trial register no. NCT00175240
Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .