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The Enhancing Secondary Prevention in Coronary Artery Disease trial

Canadian Medical Association journal, 2009-12, Vol.181 (12), p.897-904 [Peer Reviewed Journal]

COPYRIGHT 2009 Joule Inc. ;Copyright Canadian Medical Association Dec 8, 2009 ;1995-2009, Canadian Medical Association ;ISSN: 0008-4409 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.090917 ;PMID: 19933787 ;CODEN: CMAJAX

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Title:
The Enhancing Secondary Prevention in Coronary Artery Disease trial
Author: McAlister, Finlay A ; Fradette, Miriam ; Majumdar, Sumit R ; Williams, Randall ; Graham, Michelle ; McMeekin, James ; Ghali, William A ; Tsuyuki, Ross T ; Knudtson, Merril L ; Grimshaw, Jeremy
Subjects: Analysis ; Cardiac Catheterization ; Cardiovascular disease ; Care and treatment ; Cholesterol, LDL - blood ; Clinical trials ; Coronary Artery Disease - prevention & control ; Coronary heart disease ; Diagnosis ; Female ; Health aspects ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Patients ; Physicians ; Physicians, Family - education ; Practice ; Practice Guidelines as Topic ; Prevention ; Primary care ; Studies
Is Part Of: Canadian Medical Association journal, 2009-12, Vol.181 (12), p.897-904
Description: Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions, resulting in suboptimal outcomes. We evaluated whether evidence summaries, which were either unsigned or signed by local opinion leaders, improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease. We performed a randomized trial, clustered at the level of the primary care physician, with 3 study arms: control, unsigned statements or opinion leader statements. The statements were faxed to primary care physicians of adults with coronary artery disease at the time of elective cardiac catheterization. The primary outcome was improvement in statin management (initiation or dose increase) 6 months after catheterization. We enrolled 480 adults from 252 practices. Although statin use was high at baseline (n=316 [66%]), most patients were taking a low dose (mean 32% of the guideline-recommended dose), and their low-density lipoprotein (LDL) cholesterol levels were elevated (mean 3.09 mmol/L). Six months after catheterization, statin management had improved in 79 of 157 patients (50%) in the control arm, 85 of 158 (54%) patients in the unsigned statement group (adjusted odds ratio [OR] 1.18, 95% CI 0.71-1.94, p=0.52) and 99 of 165 (60%) patients in the opinion leader statement group (adjusted OR 1.51, 95% CI 0.94-2.42, p=0.09). The mean fasting LDL cholesterol levels after 6 months were similar in all 3 study arms: 2.35 (standard deviation [SD] 0.86) mmol/L in the control arm compared with 2.24 (SD 0.73) among those in the opinion leader group (p=0.48) and 2.19 (SD 0.68) in the unsigned statement group (p=0.32). Faxed evidence reminders for primary care physicians, even when endorsed by local opinion leaders, were insufficient to optimize the quality of care for adults with coronary artery disease. ClinicalTrials.gov trial register no. NCT00175240.
Publisher: Canada: Can Med Assoc
Language: English
Identifier: ISSN: 0008-4409
ISSN: 0820-3946
EISSN: 1488-2329
DOI: 10.1503/cmaj.090917
PMID: 19933787
CODEN: CMAJAX
Source: ProQuest One Psychology
Geneva Foundation Free Medical Journals at publisher websites
AUTh Library subscriptions: ProQuest Central
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The Enhancing Secondary Prevention in Coronary Artery Disease trial

COPYRIGHT 2009 Joule Inc. ;Copyright Canadian Medical Association Dec 8, 2009 ;1995-2009, Canadian Medical Association ;ISSN: 0008-4409 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.090917 ;PMID: 19933787 ;CODEN: CMAJAX

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