A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil

Background: Despite significant progress in improving the quality of cardiovascular care, persistent gaps remain in terms of inconsistent adherence to guideline recommendations.Objective: This study evaluates the effects of implementing a quality improvement program adapted from the American Heart Association's Get with the Guidelines (TM) initiative on adherence to guideline-directed medical therapy for acute coronary syndrome (ACS), atrial fibrillation (AF), and heart failure (HF).Methods: We examined demographics, quality measures, and short-term outcomes in patients hospitalized with ACS, AF, and HF enrolled in the Best Practice in Cardiology (BPC) Program from 2016 to 2022.Results: This study included 12,167 patients in 19 hospitals in Brazil. Mean age was 62.5 [53.8-71] y/o; 61.1% were male, 68.7% had hypertension, 32.0% diabetes mellitus, and 24.1% had dyslipidemia. Composite score had a sustainable performance in the period from baseline to the last quarter: 65.8 +/- 36.2% to 73 +/- 31.2% for AF (p=0.024), 81.0 +/- 23.6% to 89.9 +/- 19.3% for HF (p<0.001), and from 88.0 +/- 19.1 to 91.2 +/- 14.9 for ACS (p<0.001).Conclusions: The BPC program is a quality improvement program in Brazil in which real-time data, obtained using cardiology guideline metrics, were implemented in a quality improvement program resulting in an overall sustained improvement in AF, HF, and ACS management.