Impact of In-Hospital Quality of Care Improvement Initiative on Secondary Prevention of Acute Coronary Syndrome in Six Months After Patient Discharge: A Large Stepped Wedge- and Cluster-Randomized Controlled Trial.
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| Title: | Impact of In-Hospital Quality of Care Improvement Initiative on Secondary Prevention of Acute Coronary Syndrome in Six Months After Patient Discharge: A Large Stepped Wedge- and Cluster-Randomized Controlled Trial. |
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| Authors: | Xie G; Clinical Research Institute, Institute of Advanced Clinical Medicine (G.X., Y.W.), Peking University, Beijing, China.; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education (G.X., Y.W.), Peking University, Beijing, China.; Peking University First Hospital (G.X., Y.W.), Peking University, Beijing, China.; State Key Laboratory of Vascular Homeostasis and Remodeling (G.X., Y.W.), Peking University, Beijing, China., Patel A; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia (A.P.)., Du X; Anzhen hospital, Beijing, China (X.D., Y.S.)., Sun Y; Anzhen hospital, Beijing, China (X.D., Y.S.)., Li X; The George Institute for Global Health Beijing, China (X.L., T.W., Z.H.)., Wu T; The George Institute for Global Health Beijing, China (X.L., T.W., Z.H.)., Hao Z; The George Institute for Global Health Beijing, China (X.L., T.W., Z.H.)., Gao R; The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (R.G.)., Wu Y; Clinical Research Institute, Institute of Advanced Clinical Medicine (G.X., Y.W.), Peking University, Beijing, China.; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education (G.X., Y.W.), Peking University, Beijing, China.; Peking University First Hospital (G.X., Y.W.), Peking University, Beijing, China.; State Key Laboratory of Vascular Homeostasis and Remodeling (G.X., Y.W.), Peking University, Beijing, China.; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (Y.W.). |
| Source: | Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2025 May; Vol. 18 (5), pp. e011441. Date of Electronic Publication: 2025 Apr 04. |
| Publication Type: | Journal Article; Randomized Controlled Trial; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101489148 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7705 (Electronic) Linking ISSN: 19417713 NLM ISO Abbreviation: Circ Cardiovasc Qual Outcomes Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins |
| MeSH Terms: | Acute Coronary Syndrome*/diagnosis , Acute Coronary Syndrome*/mortality , Acute Coronary Syndrome*/prevention & control , Acute Coronary Syndrome*/therapy , Cardiovascular Agents*/therapeutic use , Outcome and Process Assessment, Health Care*/standards , Patient Discharge*/standards , Quality Improvement*/standards , Quality Indicators, Health Care*/standards , Secondary Prevention*/standards, Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology ; Critical Pathways/standards ; Patient Care Team/standards ; Patient Education as Topic ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| Abstract: | Competing Interests: None. Background: Patients discharged after acute coronary syndrome experience a high risk of major adverse cardiovascular events (MACE) within the first 6 months. We examined whether a quality of care improvement initiative implemented in hospitals affects clinical preventive management and outcomes after discharge. Methods: We used data from the third phase of the CPACS-3 study (Clinical Pathways for Acute Coronary Syndromes in China), a large stepped wedge- and cluster-randomized trial conducted from 2011 to 2015, to evaluate the effectiveness of an in-hospital quality of care improvement program on the composite score of preventive medication use and the risk of MACE in 6 months after discharge among acute coronary syndrome survivors. The intervention included establishing a quality of care improvement team, training clinical staff, implementing acute coronary syndrome clinical pathways, performance assessment and feedback, online technical support, and patient education. A total of 101 hospitals were randomized into 4 wedges, and the intervention was initiated randomly by wedge and step. Participants recruited before (control) and after (intervention) the intervention initiation were compared with generalized estimating equations, adjusting for clustering and time trend. Results: A total of 23 258 patients (11 224 in the intervention group and 12 034 in the control group), with a mean age of 63.6±11.6 years and 39% women, had available follow-up data on MACE and 14 826 patients (6813 in the intervention group and 8013 in the control group) had available data on preventive medication use at 6 months were analyzed. Compared with the control period, the mean preventive medication use score during the intervention period was higher at 6 months (65.8 versus 60.4 for intervention and control periods, adjusted mean difference, 3.7 [95% CI, 0.3-7.0]), but the 6-month incidence of MACE showed no difference (5.8% versus 6.6%, adjusted odds ratio, 1.04 [95% CI, 0.83-1.29]). Conclusions: The in-hospital multifaceted quality of care improvement intervention in resource-constrained Chinese hospitals increased preventive medication use among acute coronary syndrome survivors in the 6 months after discharge, but this did not translate into a reduction in MACE. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01398228. |
| Contributed Indexing: | Keywords: acute coronary syndrome; clinical trial; quality improvement; secondary prevention |
| Molecular Sequence: | ClinicalTrials.gov NCT01398228 |
| Substance Nomenclature: | 0 (Cardiovascular Agents) |
| Entry Date(s): | Date Created: 20250404 Date Completed: 20250521 Latest Revision: 20250625 |
| Update Code: | 20250626 |
| PubMed Central ID: | PMC12084016 |
| DOI: | 10.1161/CIRCOUTCOMES.124.011441 |
| PMID: | 40184150 |
| Database: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: None.<br />Background: Patients discharged after acute coronary syndrome experience a high risk of major adverse cardiovascular events (MACE) within the first 6 months. We examined whether a quality of care improvement initiative implemented in hospitals affects clinical preventive management and outcomes after discharge.<br />Methods: We used data from the third phase of the CPACS-3 study (Clinical Pathways for Acute Coronary Syndromes in China), a large stepped wedge- and cluster-randomized trial conducted from 2011 to 2015, to evaluate the effectiveness of an in-hospital quality of care improvement program on the composite score of preventive medication use and the risk of MACE in 6 months after discharge among acute coronary syndrome survivors. The intervention included establishing a quality of care improvement team, training clinical staff, implementing acute coronary syndrome clinical pathways, performance assessment and feedback, online technical support, and patient education. A total of 101 hospitals were randomized into 4 wedges, and the intervention was initiated randomly by wedge and step. Participants recruited before (control) and after (intervention) the intervention initiation were compared with generalized estimating equations, adjusting for clustering and time trend.<br />Results: A total of 23 258 patients (11 224 in the intervention group and 12 034 in the control group), with a mean age of 63.6±11.6 years and 39% women, had available follow-up data on MACE and 14 826 patients (6813 in the intervention group and 8013 in the control group) had available data on preventive medication use at 6 months were analyzed. Compared with the control period, the mean preventive medication use score during the intervention period was higher at 6 months (65.8 versus 60.4 for intervention and control periods, adjusted mean difference, 3.7 [95% CI, 0.3-7.0]), but the 6-month incidence of MACE showed no difference (5.8% versus 6.6%, adjusted odds ratio, 1.04 [95% CI, 0.83-1.29]).<br />Conclusions: The in-hospital multifaceted quality of care improvement intervention in resource-constrained Chinese hospitals increased preventive medication use among acute coronary syndrome survivors in the 6 months after discharge, but this did not translate into a reduction in MACE.<br />Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01398228. |
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| ISSN: | 1941-7705 |
| DOI: | 10.1161/CIRCOUTCOMES.124.011441 |