CMAJ • December 8, 2009; 181 (12). First published November 23, 2009; doi:10.1503/cmaj.090917
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Appendix
Right arrow All Versions of this Article:
cmaj.090917v1
181/12/897    most recent
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Google Scholar
Right arrow Articles by McAlister, F. A.
Right arrow Articles by Grimshaw, J.
PubMed
Right arrow PubMed Citation
Right arrow Articles by McAlister, F. A.
Right arrow Articles by Grimshaw, J.
Related Collections
Right arrowRelated Article

Research

The Enhancing Secondary Prevention in Coronary Artery Disease trial

Finlay A. McAlister, MD MSc, Miriam Fradette, BSc Pharm, Sumit R. Majumdar, MD MPH, Randall Williams, MD, Michelle Graham, MD, James McMeekin, MD, William A. Ghali, MD MPH, Ross T. Tsuyuki, PharmD MSc, Merril L. Knudtson, MD and Jeremy Grimshaw, MB ChB PhD

From the Department of Medicine (McAlister, Majumdar, Graham, Tsuyuki), University of Alberta; the Epidemiology Coordinating and Research Centre (McAlister, Fradette, Majumdar, Graham, Tsuyuki), University of Alberta; the Mazankowski Alberta Heart Institute (McAlister, Graham, Tsuyuki), University of Alberta; the Royal Alexandra Hospital (Williams), Edmonton, Alta.; the Department of Medicine (McMeekin, Ghali, Knudtson), University of Calgary, Calgary, Alta.; and the University of Ottawa Health Research Unit (Grimshaw), Ottawa, Ont.

Correspondence to: Dr. Finlay A. McAlister, Division of General Internal Medicine, 2F1.21 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440-112th St., Edmonton AB T6G 2B7; fax 780 407-3132; finlay.mcalister{at}ualberta.ca

Background: 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.

Methods: 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.

Results: 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).

Interpretation: 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.


Related Article

Highlights
Can. Med. Assoc. J. 2009 181: 873. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 CMAJHome page
N. M. Ivers
Why didn't it work?
Can. Med. Assoc. J., February 9, 2010; 182(2): 175 - 175.
[Full Text] [PDF]

eLetters:

Read all eLetters

Understanding why didn’t the intervention work
Noah M Ivers MD CCFP
CMAJ, 4 Jan 2010 [Full text]