Interventions in the diagnosis and adoption of pacemaker therapy in sinus node dysfunction patients: Results from the IMPROVE Brady study
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Date
2022-10
Journal Title
Journal ISSN
Volume Title
Publisher
Cardiological Society of India
Abstract
Aims: IMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients. Methods: /Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant. A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001). Conclusions: A process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.
Description
Keywords
Sinus node dysfunction, Bradycardia, Pacemaker therapy, Process improvement
Citation
Sethi Rishi, Malik Fazila Tun Nesa, Naik Ajay, Afroz Nadeem, Reynolds Dwight W., Kothari Yogesh, Reddy Vijayachandra, Rajan Vinayakrishnan, Bergemann Tracy, Dedrick Alexandra, Pandurangi Ulhas M., Khan Kaiswer Nasrullah, Narasimhan Calambur. Interventions in the diagnosis and adoption of pacemaker therapy in sinus node dysfunction patients: Results from the IMPROVE Brady study. Indian Heart Journal. 2022 Oct; 74(5): 351-356