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 .
Cluster-randomized trial to evaluate the effects of a quality improvement program on management of non-ST-elevation acute coronary syndromes: The European Quality Improvement Programme for Acute Coronary Syndromes (EQUIP-ACS).
BACKGROUND Registries have shown that quality of care for acute coronary syndromes ( ACS ) often falls below the st and ards recommended in professional guidelines . Quality improvement ( QI ) is a strategy to improve st and ards of clinical care for patients , but the efficacy of QI for ACS has not been tested in r and omized trials . METHODS We undertook a prospect i ve , cluster-r and omized , multicenter , multinational study to evaluate the efficacy of a QI program for ACS . Participating centers collected data on consecutive admissions for non-ST-elevation ACS for 4 months before the QI intervention and 3 months after . Thirty-eight hospitals in France , Italy , Pol and , Spain , and the United Kingdom were r and omized to receive the QI program or not , 19 in each group . We measured 8 in-hospital quality indicators ( risk stratification , coronary angiography , anticoagulation , β-blockers , statins , angiotensin-converting enzyme inhibitors , and clopidogrel loading and maintenance ) before and after the intervention and compared composite changes between the QI and non-QI groups . RESULTS A total of 2604 patients were enrolled . The absolute overall change in use of quality indicators in the QI group was 8.5 % compared with 0.8 % in the non-QI group ( odds ratio for achieving a quality indicator in QI versus non-QI 1.66 , 95 % CI 1.43 - 1.94 ; P < .001 ) . The main changes were observed in the use of risk stratification and clopidogrel loading dose . CONCLUSIONS The QI strategy result ed in a significant improvement in the quality indicators measured . This type of QI intervention can lead to useful changes in health care practice for ACS in a wide range of setting
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 .