Análisis de los resultados económicos y en salud de un programa dirigido a la reducción de hemorragia en pacientes con síndrome coronario agudo / Clinical and economic impact of a multisciplinary intervention to reduce bleeding risk in patients with acute coronary syndrome

Introducción y objetivos: Analizar los resultados económicos y en salud de un programa dirigido a reducir las hemorragias mediante la optimización del uso de fármacos antitrombóticos en pacientes con síndrome coronario agudo. Métodos: Estudio analítico, observacional, de cohortes, retrospectivo con evaluación preintervención (PRE) y posintervención (POST). En la primera cohorte se analizaron las situaciones corregibles relacionadas con un aumento de hemorragias (PRE). Posteriormente, se implantó un paquete de intervenciones y, en tercer lugar, se analizó el impacto del paquete en la reducción de hemorragias en una segunda cohorte (POST). La eficiencia se analizó considerando los ahorros derivados de la prevención de hemorragias y los costes de la implantación de las intervenciones. El análisis de los resultados en salud se calculó por el porcentaje de hemorragias intrahospitalarias y la tasa de reingresos a los 30 días. Resultados: Se incluyó a 677 pacientes (377 en PRE y 300 en POST). La intervención se asoció a una reducción en la probabilidad de desarrollar hemorragias de un 29,2% (31,6% en POST frente a 22,3% en PRE; OR = 0,62; IC95%, 0,44-0,88). La tasa de reingresos se redujo del 7,7% en PRE al 5% en POST (p = 0,20). El coste anual evitado se estimó en 95.113,6 euros, mientras que respecto al retorno de la inversión se calculó que, por cada euro invertido, se obtuvieron 10,1 euros de ahorro en el primer año y 36,3 euros en los siguientes. Conclusiones: Un programa multidisciplinario para reducir el riesgo de hemorragias en pacientes con síndrome coronario agudo es eficaz y económicamente atractivo (AU)

Introduction and objectives: To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. Methods: We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. Results: A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P = .20). The estimated avoided cost was euros95 113.6 per year, meaning that euros10.1 would be obtained in return for each euro invested during the first year and euros36.3 during the following years. Conclusions: This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive (AU)

Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome.

INTRODUCTION AND OBJECTIVES: To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. METHODS: We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. RESULTS: A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P=.20). The estimated avoided cost was €95 113.6 per year, meaning that €10.1 would be obtained in return for each euro invested during the first year and €36.3 during the following years. CONCLUSIONS: This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive.

Effectiveness of a pilot intervention to reduce abciximab-related bleeding in patients with acute coronary syndromes.

BACKGROUND AND OBJECTIVE: Reducing bleeding events is a priority in patients diagnosed with acute coronary syndromes (ACS). The effectiveness of optimization measures for reducing abciximab-related bleeding was evaluated through the implementation of a pilot program developed by the Pharmacy and the Cardiology Departments at a tertiary-care hospital. MAIN OUTCOME MEASURE: Percentage of bleeding events. RESULTS: Intervention was effective in reducing the incidence of the three factors associated with an increased risk of bleeding between the pre-intervention phase (n = 86) and the post-intervention phase (n = 73): unknown body weight (24.4 vs. 1.4 %, p = 0.0001), overdosing (31.4 vs. 0 %, p < 0.0001) and combination with bivalirudin (12.8 vs. 1.4 %, p = 0.016). Bleeding events associated with these factors were numerically reduced in all three cases but these differences were not statistically significant between both periods. CONCLUSION: The implementation of a multidisciplinary prevention program can reduce situations associated with an increased risk of bleeding in patients treated with abciximab. Larger scale trials are needed to confirm whether such programs can also reduce the incidence of bleeding at a statistically significant level.