P1701Randomized cluster trial to improve guideline-adherence of secondary preventive drugs prescription after coronary artery bypass grafting in China

Abstract

Background: The benefits of secondary preventive drugs after coronary artery bypass grafting have been thoroughly established. However, the prescription rates of these drugs are low at discharge in China. Objective(s): We sought to evaluate the effectiveness of continuous quality improvement with mobile-based interventions for clinicians on improving the guideline-adherence of secondary preventive drugs prescription. Method(s): MISSION-1 study is a cluster-randomized controlled trial. Hospitals participating in the China cardiac surgery registry were invited and randomly into the intervention group or the control group in a 1:1 ratio. The intervention group undertakes a series of mobile-based interventions, while the control group maintains a routine practice pattern. All sites consecutively register patients underwent isolated CABG and submit in-hospital data. We require supporting documents regarding prescription information at discharge to adjudicate the outcome measures. The primary outcome measure is the prescription rate of statins for eligible patients at discharge. The secondary outcome measures are antiplatelet drugs, beta-blockers and AECIs or ARBs. Result(s): A total of 58 hospitals and treating 11782 patients undergoing isolated CABG were randomized to either the intervention group (n=6659) or the control group (n=5124). Prerandomization treatment patterns and baseline were similar in the intervention group and control group. Secondary prevention medication prescription rate for eligible patients at discharge increased over 15 months in both groups, with an increment for statins (73.7% to 86.8%, 74.1% to 86.3%), beta- blockers (74.7% to 89.6%, 77.3% to 86.1%), anti-platelets drugs (90.7% to 95.8%, 90.5% to 95.6%) and ACEI/ARB (24.5% to 28.2%, 25.6% to 28.1%) of intervention group and control group respectively. We also made time trend analysis with interrupted time-series model. Conclusion(s): Continuous quality improvement clinicians can improve the guideline-adherence of secondary preventive drugs prescription. The findings of this trial can be an example for ongoing cardiac surgery quality improvement in China. (Figure Presented) .