In low and middle-income countries, the implementation of evidence-based therapies for cardiovascular disease, including the use of statins, antiplatelet therapy and anti-hypertensive medications, remains a challenge, despite high associated morbidity and mortality. In this cluster randomized controlled trial, 1619 patients with established atherosclerotic disease from 40 public and private outpatient clinics (clusters) in Brazil were randomized to receive either a multifaceted quality improvement intervention, including educational materials, feedback reports, and case management or routine care, to evaluate whether such an intervention can improve the prescription of evidence-based therapies. Researchers found that patients who received the intervention were more likely to receive evidence-based medications, as 73.5% of patients received them versus 58.7% of patients receiving usual care (OR 2.30, 95% CI 1.14 to 4.65). Additionally, smokers in the intervention group were more likely to receive smoking cessation education, as compared to those in the usual care group (51.9% vs 18.2%, OR 11.24, 95% CI 2.20 to 57.43). However, no differences were observed in diabetic, hypertensive, or hyperlipidemic control. Mortality rate was also not significantly different for the intervention group when compared with the control arm (2.6% vs. 3.4%, HR 0.76, 95% CI 0.43 to 1.34). In this Brazilian population with known atherosclerotic disease, a multimodal quality improvement intervention resulted in an increased proportion of patients receiving evidence-based therapies for cardiovascular disease, including smoking cessation education although outcomes at 1-2 years were unaffected.
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