Derek P Chew1, Carolyn M Astley2, Heather Luker3, Bernadette Alprandi-Costa3, Graham Hillis4, Clara K Chow5, Steve Quinn1, Andrew T Yan6, Chris P Gale7, Shaun Goodman6, Keith A A Fox8, David Brieger3. 1. School of Medicine, Flinders University of South Australia, Adelaide, Australia. 2. School of Medicine, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health/Flinders University, Adelaide, Australia. 3. Concord Hospital, University of Sydney, Sydney, Australia. 4. School of Medicine, University of Western Australia, Perth, Australia. 5. The George Institute for Global Health, University of Sydney and Westmead Hospital, Sydney, Australia; Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 6. Heart & Stroke Foundation of Ontario, Department of Medicine, University of Toronto, Toronto, Canada. 7. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 8. University of Edinburgh, Edinburgh, UK.
Abstract
BACKGROUND: Assessing risk and weighing the potential benefits from evidence-based therapies are essential in the clinical decision making process of optimizing care and outcomes for patients presenting with acute coronary syndromes (ACS). Such practices are advocated in international clinical guidelines of ACS care. While the GRACE risk score (GRS) is a guideline advocated, well-validated risk stratification tool, its utility in improving care and outcomes remains unproven, and its application has been limited in routine clinical practice. OBJECTIVE: This study will assess the effectiveness using the GRS tool and treatment recommendations during patient assessment on improving the application of guideline-recommended therapies in ACS care. DESIGN: This study employs a PROBE (prospective cluster [hospital-level] randomized open-label, blinded endpoint) design to evaluate objective measures of hospital performance, with clinical events adjudicated by a blinded event committee. This randomized study is nested within the established CONCORDANCE registry of ACS patients, with existing methods for data collection and monitoring of care and clinical outcomes. The hospital-level intervention is the integration of the GRS into routine ACS patient assessment process. The study will assess the use of early invasive management, prescription of guideline recommended pharmacology and referral to cardiac rehabilitation by hospital discharge; with the key composite clinical endpoint of cardiovascular death, new or recurrent myocardial infarction, in-hospital heart failure or cardiovascular readmission at 12 months. Health economic impacts of risk stratification implementation will also be evaluated. The study will recruit 3000 patients from 30 hospitals. SUMMARY: The AGRIS trial will establish the effect of routine objective risk stratification using the GRACE risk score on ACS care and clinical outcomes.
BACKGROUND: Assessing risk and weighing the potential benefits from evidence-based therapies are essential in the clinical decision making process of optimizing care and outcomes for patients presenting with acute coronary syndromes (ACS). Such practices are advocated in international clinical guidelines of ACS care. While the GRACE risk score (GRS) is a guideline advocated, well-validated risk stratification tool, its utility in improving care and outcomes remains unproven, and its application has been limited in routine clinical practice. OBJECTIVE: This study will assess the effectiveness using the GRS tool and treatment recommendations during patient assessment on improving the application of guideline-recommended therapies in ACS care. DESIGN: This study employs a PROBE (prospective cluster [hospital-level] randomized open-label, blinded endpoint) design to evaluate objective measures of hospital performance, with clinical events adjudicated by a blinded event committee. This randomized study is nested within the established CONCORDANCE registry of ACS patients, with existing methods for data collection and monitoring of care and clinical outcomes. The hospital-level intervention is the integration of the GRS into routine ACS patient assessment process. The study will assess the use of early invasive management, prescription of guideline recommended pharmacology and referral to cardiac rehabilitation by hospital discharge; with the key composite clinical endpoint of cardiovascular death, new or recurrent myocardial infarction, in-hospital heart failure or cardiovascular readmission at 12 months. Health economic impacts of risk stratification implementation will also be evaluated. The study will recruit 3000 patients from 30 hospitals. SUMMARY: The AGRIS trial will establish the effect of routine objective risk stratification using the GRACE risk score on ACS care and clinical outcomes.
Authors: Derek P Chew; Karice Hyun; Erin Morton; Matt Horsfall; Graham S Hillis; Clara K Chow; Stephen Quinn; Mario D'Souza; Andrew T Yan; Chris P Gale; Shaun G Goodman; Keith Fox; David Brieger Journal: JAMA Cardiol Date: 2021-03-01 Impact factor: 14.676
Authors: Janice Gullick; John Wu; Derek Chew; Chris Gale; Andrew T Yan; Shaun G Goodman; Donna Waters; Karice Hyun; David Brieger Journal: BMC Health Serv Res Date: 2022-03-22 Impact factor: 2.655
Authors: Marlous Hall; Owen J Bebb; Tatandashe B Dondo; Andrew T Yan; Shaun G Goodman; Hector Bueno; Derek P Chew; David Brieger; Philip D Batin; Michel E Farkouh; Harry Hemingway; Adam Timmis; Keith A A Fox; Chris P Gale Journal: Eur Heart J Date: 2018-11-07 Impact factor: 35.855
Authors: Colin C Everett; Keith Aa Fox; Catherine Reynolds; Catherine Fernandez; Linda Sharples; Deborah D Stocken; Kathryn Carruthers; Harry Hemingway; Andrew T Yan; Shaun G Goodman; David Brieger; Derek P Chew; Chris P Gale Journal: BMJ Open Date: 2019-09-05 Impact factor: 2.692