ABC | Volume 115, Nº1, July 2020

92 Original Article Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines ® in Brazilian Public Hospitals: Study Design and Rationale Fabio Papa Taniguchi, 1 Sabrina Bernardez-Pereira, 1 Suzana Alves Silva, 1 Antônio Luiz Pinho Ribeiro, 2 Louise Morgan, 3 Anne B. Curtis, 4 Kathryn Taubert, 5 Denilson Campos de Albuquerque, 6 Bernadete Weber, 1 Pedro Paulo Magalhães Chrispim, 1 Camila Pereira Pinto Toth, 1 Erica Deji Moura Morosov, 1 Gregg C. Fonarow, 7 Sidney C. Smith Jr., 8 Angelo Amato Vincenzo de Paola 9 Hospital do Coração, 1 São Paulo, SP – Brazil Universidade Federal de Minas Gerais (UFMG), 2 Belo Horizonte, MG – Brazil American Heart Association Inc, 3 Dallas, Texas – USA University at Buffalo - The State University of New York, 4 Buffalo, New York – USA American Heart Association Switzerland, 5 Basel – Switzerland Universidade do Estado do Rio de Janeiro (UERJ), 6 Rio de Janeiro, RJ – Brazil University of California Los Angeles, 7 Los Angeles, Califórnia – USA University of North Carolina at Chapel Hill, 8 Chapel Hill, North Carolina – USA Universidade Federal de São Paulo Escola Paulista de Medicina, 9 São Paulo, SP – Brazil Mailing Address: Fabio Papa Taniguchi • Hospital do Coração - Rua Desembargador Eliseu Guilherme,147. Postal Code 04004-030, São Paulo, SP - Brazil E-mail: ftaniguchi@hcor.com.br Manuscript received July 18, 2019, revised manuscript August 14, 2019, accepted August 14, 2019 DOI: https://doi.org/10.36660/abc.20190393 Abstract Background: There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective: To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods: The Boas Práticas em Cardiologia (BPC) programwas adapted from the American Heart Association’s (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to caremeasures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients’ health perception and patients’ adherence to prescribed interventions. Results: It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence- based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions: This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0) Keywords: Cardiovascular Diseases/physiopathology; Heart Failure; Atrial Fibrillation; Acute Coronary Syndrome; Quality Improvement/trends; Guidelines as Topic. Introduction The Brazilian public health system serves about 70% of the country’s population and functions as Brazil’s primary health care delivery system. 1 Despite a number of initiatives taken by the federal government to improve the efficiency of the Brazilian public health system, results have been inconsistent, indicating a great need for improvement. 1,2 Furthermore, little has been done to control the under- or overutilization of healthcare resources and barriers that prevent evidence-based therapies from being implemented at the national level. 2 Significant variability in the quality of care, assessed through performance measures by Brazilian health institutions with the support of the Brazilian Society of Cardiology (SBC), has been observed. 3-5 Educational initiatives and programs for quality improvement (QI) have been shown to help improve