ABC | Volume 115, Nº1, July 2020

94 Original Article Taniguchi et al. Best practice in cardiology (BPC) program Arq Bras Cardiol. 2020; 115(1):92-99 Data collection Clinical data from the patients included will be registered on a web database (MySQL version 5.7 or higher) developed specifically for this project. Each hospital will be responsible for its own data collection by a trained local team of data abstractors who will work under the supervision of their local leadership. Data will be abstracted from medical charts and structured interviews made directly with the patients during hospitalization and at one and six months of follow-up. Data will include demographics, comorbidities and risk factors, symptoms on arrival, health literacy, risk profile according to international standards for each arm of the program, 17-21 in- and out-of-hospital treatment and procedures, discharge medications and secondary prevention, discharge counseling and patients’ adherence to recommendations. Data Management and Quality Control All data will be treated as protected health information and securely stored centrally in a password-protected web server, accessible in real time by any approved user through a web browser. Data accuracy and completeness will be ensured by following the same methodologies of the GWTG. 22,23 QI Interventions and Hospital Recognition As opposed to the approach taken in the U.S., the Brazilian program uses a didactic framework based on Michie et al. 24 Interventions were grouped in seven domains aiming to cause behavioral change (facilitation and restriction; modeling; environmental restructuring; education; incentives Table 1 – Performance measures Time Performance measure Definition HF AF ACS Within 24h of arrival Early Aspirin* Proportion of ACS patients receiving aspirin within 24 hours of hospital arrival ● Proper reperfusion therapy Proportion of STEAMI patients submitted to thrombolysis within 30 min or primary angioplasty within 90 min from hospital arrival ● During hospitalization Assessment of thromboembolic risk factors Proportion of non-valvular AF/Flutter patients with a documented CHADS2-VASc risk score assessment ● Bleeding risk assessment Proportion of patient with a documented HAS-BLED risk score assessment. ● Assessment of left ventricle function Proportion of HF patients with a documented LV function either in the medical records or other reports accessible in hospital charts in the 12 months before admission or during hospitalization or with a scheduled evaluation planned to be performed after discharge ● At discharge Aspirin* Proportion of ACS patients with aspirin prescribed at discharge ● ACEI/ARB* Proportion of HF patients with LVEF < 40% or AF patients with LVEF ≤ 40% or ACS patients with LVEF < 45% with an ACEI/ARB prescribed at discharge ● ● ● Beta blockers* Proportion of HF patients with LVEF ≤ 40% and a proven efficacious beta blocker (Bisoprolol, Carvedilol, Metoprolol Succinate CR/XL) prescribed at discharge ● ● ● Proportion of ACS patients with a beta blocker prescribed at discharge Proportion or AF patients with either LVEF ≤ 40% or CAD with a beta blocker prescribed at discharge Anticoagulants* Proportion of AF patients at high risk for thromboembolism according to the CHADS2_VASc taking anticoagulants ● Statin* Proportion of AF patients with CAD, stroke/TIA, PVD or diabetes who were prescribed a statin at discharge ● ● Proportion of ACS patients without contraindications with statin prescribed for LDL control at discharge Aldosterone inhibitors* Proportion of HF patients with LVEF ≤ 35% taking aldosterone inhibitors ● Blood pressure control Proportion of ACS patients under medication for blood pressure control ● Smoke cessation counseling Proportion of ACS patients, who are active smoker within the past 12 months, who receive smoking cessation advice during hospitalization or at discharge ● Returning visit appointment Proportion of AF patients discharged on Warfarin who had an INR follow up planned prior to hospital discharge ● Post-discharge appointment Proportion of HF patients for whom a follow-up appointment was scheduled and documented ● * Only eligible patients, without contraindications, will be computed in the denominator. ACS: acute coronary syndrome; ACEI: angiotensin-converting enzyme inhibitor; AF: atrial fibrillation; ARB: angiotensin receptor blocker; CAD: coronary artery disease. CVA: cerebrovascular accident; HF: heart failure; INR: international normalized ratio; LDL: low density lipoprotein; LV: left ventricle; LVEF: left ventricle ejection fraction; PVD: peripheral vascular disease; STEAMI: ST elevation acute myocardial infarction; TIA: transient ischemic attack.