Knowledge Translation for Patients With Acute Coronary Syndromes

Study Overview
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Brief Summary
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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
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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.

Official Title
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Knowledge Translation to Promote Evidence-based Medical Therapy in Acute Coronary Syndromes

Conditions
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Acute Coronary Syndromes

Intervention / Treatment
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* Behavioral: knowledge translation


Participation Criteria
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Eligibility Criteria
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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 -
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: knowledge translation<br>knowledge translation 12-month multi-facet intensive knowledge translation measures that include: Community of practice, local gap analysis, opinion leaders, targeted interventions, performance feedback, reminders and local formation of ACS teams. | Behavioral: knowledge translation<br>* knowledge translation that include: Community of practice, local gap analysis, opinion leaders, targeted interventions, performance feedback, reminders and local formation of ACS teams.<br>|
| No Intervention: Usual care<br>no intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who received evidence-based medical therapy at hospital discharge (mean of 4 days) | Evidence-based medical therapy is defined as aspirin,dual-antiplaquelets, beta-blockers, statins. | at hospital discharge (average of 4 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discharge prescription of individual evidence-based medical therapy: aspirin, dual antiplatelets, beta-blockers | 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). | at hospital discharge (average of 4 days) | 
| Safety endpoints (mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds)) | mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds) | in-hospital (average of 4 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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myocardial infarction, knowledge transfer, acute coronary syndromes