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A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil
Fabio Papa Taniguchi1, Sabrina Bernardez-Pereira1, Antônio Luiz Pinho Ribeiro2
1Hospital do Coração, São Paulo, SP - Brasil.
Insights
The Best Practice in Cardiology program improved patient care for atrial fibrillation (AF), heart failure (HF), and acute coronary syndrome (ACS). This quality improvement initiative demonstrated sustained performance gains across these cardiovascular conditions in Brazil.
Area of Science:
- Cardiology
- Quality Improvement Science
- Public Health Initiatives
Background:
- Despite advancements in cardiovascular care, adherence to clinical guidelines remains inconsistent.
- The Best Practice in Cardiology (BPC) program in Brazil was established to address these quality gaps.
- The program is modeled after the American Heart Association's Get with the Guidelines™ initiative.
Purpose of the Study:
- To evaluate the impact of the BPC program on guideline-directed medical therapy adherence.
- The study focused on patients with acute coronary syndrome (ACS), atrial fibrillation (AF), and heart failure (HF).
Main Methods:
- A retrospective analysis of 12,167 patients across 19 Brazilian hospitals from 2016 to 2022.
- Data included patient demographics, quality metrics, and short-term outcomes.
- The BPC program utilized real-time data and cardiology guideline metrics.
Main Results:
- The BPC program showed sustained performance improvements.
- Adherence scores improved significantly for AF (65.8% to 73%, p=0.024), HF (81.0% to 89.9%, p<0.001), and ACS (88.0% to 91.2%, p<0.001).
- The study population comprised 61.1% males, with high prevalence of hypertension (68.7%) and diabetes (32.0%).
Conclusions:
- The BPC program effectively enhanced the management of AF, HF, and ACS.
- Implementation of real-time data and guideline metrics led to sustained quality improvements.
- This initiative highlights the success of quality improvement programs in cardiovascular medicine.
Background:
A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil ACEI/ARB: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; LVEF: left ventricular ejection fraction; LVSD: left ventricular systolic dysfunction; AF: atrial fibrillation; PT/INR: prothrombin time/international normalized ratio.
Background:
Despite significant progress in improving the quality of cardiovascular care, persistent gaps remain in terms of inconsistent adherence to guideline recommendations.
Objective:
This study evaluates the effects of implementing a quality improvement program adapted from the American Heart Association's Get with the Guidelines™ initiative on adherence to guideline-directed medical therapy for acute coronary syndrome (ACS), atrial fibrillation (AF), and heart failure (HF).
Methods:
We examined demographics, quality measures, and short-term outcomes in patients hospitalized with ACS, AF, and HF enrolled in the Best Practice in Cardiology (BPC) Program from 2016 to 2022.
Results:
This study included 12,167 patients in 19 hospitals in Brazil. Mean age was 62.5 [53.8-71] y/o; 61.1% were male, 68.7% had hypertension, 32.0% diabetes mellitus, and 24.1% had dyslipidemia. Composite score had a sustainable performance in the period from baseline to the last quarter: 65.8±36.2% to 73± 31.2% for AF (p=0.024), 81.0± 23.6% to 89.9 ± 19.3% for HF (p<0.001), and from 88.0 ± 19.1 to 91.2 ±14.9 for ACS (p<0.001).
Conclusions:
The BPC program is a quality improvement program in Brazil in which real-time data, obtained using cardiology guideline metrics, were implemented in a quality improvement program resulting in an overall sustained improvement in AF, HF, and ACS management.
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