{"id":"bd08020ffb14","type":"article","url":"https://hartvaat.nl/2019/05/01/kwaliteitsverbetering-en-evidence-based-prescriptie-bij-hoog-cv-risico-jama-card/","title":"Kwaliteitsverbetering en evidence-based prescriptie bij hoog CV-risico: JAMA Cardiology","title_en":"Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Evidence-Based Treatment in Patients at High Cardiovascular Risk in Brazil: The BRIDGE Cardiovascular Prevention Cluster Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["aperitif-trial","biomarkers-cardiovasculair","farmaco-economie","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.0649","source_url":"https://doi.org/10.1001/jamacardio.2019.0649","authors":["M Julia Machline-Carrion","Rafael Marques Soares","Lucas Petri Damiani","Viviane Bezerra Campos","Bruna Sampaio","Francisco H Fonseca","Maria Cristina Izar","Celso Amodeo","Octávio Marques Pontes-Neto","Juliana Yamashita Santos","Samara Pinheiro do Carmo Gomes","José Francisco Kerr Saraiva","Eduardo Ramacciotti","Pedro Gabriel de Melo Barros E Silva","Renato D Lopes","Nilton Brandão da Silva","Hélio Penna Guimarães","Leopoldo Piegas","Airton T Stein","Otávio Berwanger"],"significance":6,"published":"2019-05-01","source_date":"2019-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA Cardiology trial tested whether a multifaceted quality improvement intervention increases evidence-based treatment prescribing in high-risk cardiovascular patients in community practice.","created":"2026-07-03T10:27:54Z","updated":"2026-07-03T13:27:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology trial naar het effect van een kwaliteitsverbeteringsinterventie op het voorschrijven van evidence-based behandeling bij hoog CV-risicopatiënten.","abstract_original":"IMPORTANCE: Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. OBJECTIVE: To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. DESIGN, SETTING, AND PARTICIPANTS: In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. INTERVENTIONS: Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. MAIN OUTCOMES AND MEASURES: The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. RESULTS: Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). CONCLUSIONS AND RELEVANCE: Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02851732."}