Enhancing the Secondary Prevention of Coronary Artery Disease
Ischemic Heart Disease
Behavioral: Evidence summaries endorsed by local opinion leaders
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Primary Purpose: Prevention
|Official Title:||Enhancing the Use of Secondary Prevention Strategies in Patients With Coronary Artery Disease (The ESP-CAD Study)|
- Composite measure representing improvement in cholesterol-related secondary prevention consisting of (1) provision of a statin sample (2) provision of a statin prescription or (3) dosage increase of a statin within the first 6 months post-angiogram.
- Provision of other proven efficacious medications for coronary artery disease by 6 months including ACE inhibitors, beta-blockers and antiplatelet agents.
- Changes in the provision of other lipid lowering medications.
- Smoking rates - receipt of smoking cessation advice/nicotine replacement products/bupropion.
- Repeat fasting lipid panel within 6 months post-angiogram.
- Proportion of patients achieving target LDL-C of 2.0mmol/l or less.
- Clinical events including myocardial infarction, stroke, admissions for coronary artery disease, total hospitalizations and mortality.
|Study Start Date:||March 2005|
|Study Completion Date:||July 2015|
|Primary Completion Date:||August 2011 (Final data collection date for primary outcome measure)|
BACKGROUND: Despite the abundant evidence base for secondary prevention, practice audits consistently demonstrate substantial "care gaps" between this evidence and clinical reality such that many patients with Coronary Artery Disease (CAD) are not offered all possible therapies for the prevention of myocardial infarction or death. For example, even after an acute myocardial infarction, almost one fifth of patients continue to smoke; over half with hypertension or hyperlipidemia have poorly controlled pressure or lipid levels; and proven therapies such as statins, ACE inhibitors, beta-blockers and antiplatelet agents are under-prescribed.
Multiple barriers are often responsible for the lack of implementation of proven efficacious therapies and traditional means of educating practitioners (journal articles, CME, conferences, etc) are usually ineffective in altering practice. Clearly novel interventions to improve the quality of prescribing are needed. Local opinion leaders are trusted by their peers to evaluate medical innovations and thus influence practice patterns within their community. Few controlled studies, however, have evaluated their effect on changing prescribing practices for common conditions such as CAD.
HYPOTHESIS: This trial will test 2 quality improvement interventions. The principle hypothesis is: does a one-page evidence summary endorsed by local opinion leaders increase the provision of secondary prevention therapies in patients with CAD compared to usual care? The secondary hypotheses are: does the same intervention but without local opinion leader endorsement improve the provision of secondary prevention strategies in patients with CAD compared to usual care? Does local opinion leader endorsement increase the effectiveness of the quality improvement intervention?
Please refer to this study by its ClinicalTrials.gov identifier: NCT00175240
|University of Alberta Hospital; Royal Alexandra Hospital, Foothills Medical Centre (Calgary)|
|Edmonton, Alberta, Canada, T6G 2B7|
|Principal Investigator:||Finlay McAlister, MD,MSc||University of Alberta|