Clinical Pathways for the Management of Acute Coronary Syndromes - Phase 3,CPACS-3
CPACS-3
1 other identifier
interventional
29,934
1 country
102
Brief Summary
The burden of chronic, non-communicable disease, of which cardiovascular disease comprises a significant component, has increased rapidly and substantially in China over recent years. Over the coming decades China is predicted to experience a 69% increase in acute coronary disease(ACS), amounting to nearly 8 million additional events. A recent randomized trial of more than 15,000 patients with acute coronary syndromes, the second phase of Clinical Pathway for acute coronary syndromes in China (CPACS-2) study, showed that a quality improvement initiative could improve aspects of hospital care, including the proportion of patients discharged on appropriate medication. The study also identified a number of barriers to improved care including out of pocket costs and administration systems. However, the study was not able to determine the impact on clinical outcomes or the cost-effectiveness of the intervention. The aim of the third phase of the Clinical Pathway for acute coronary syndromes in China (CPACS-3) study is to determine whether a complex intervention comprising a clinical pathway for ACS management in combination with a number of physician and patient-oriented education tools can improve the quality of care and health outcomes among ACS patient admitted to resource-limited (provincial) hospitals. The effectiveness of the intervention will be evaluated using a cluster randomized trial (stepped wedge design) of ACS patients admitted to 104 hospitals in China. The study will incorporate two additional components (1) a qualitative substudy to identify the barriers and enablers to improved care and (2) a study comparing the cost-effectiveness of the intervention compared to usual care, from the perspective of the health care provider. The study will be conducted in conjunction with the Chinese Ministry of Health and the Chinese Society of Cardiology. The findings from CPACS3 will be able to inform health policy-makers about the extent to which quality improvement initiatives can reduce the risk of death and disability among the millions of ACS patients admitted to hospitals in China each year.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Sep 2011
Longer than P75 for not_applicable
102 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
July 18, 2011
CompletedFirst Posted
Study publicly available on registry
July 20, 2011
CompletedStudy Start
First participant enrolled
September 1, 2011
CompletedPrimary Completion
Last participant's last visit for primary outcome
December 1, 2014
CompletedStudy Completion
Last participant's last visit for all outcomes
June 1, 2015
CompletedAugust 10, 2016
August 1, 2016
3.3 years
July 18, 2011
August 8, 2016
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
incidence rate of in-hospital major adverse cardiovascular events (MACE)
In-hospital major adverse cardiovascular events (MACE) comprising all-cause mortality, myocardial infarction or recurrent myocardial infarction and non-fatal stroke.The in-hospital mortality will include patients who deid during hospitalization, patients who gave up treatment and home and die within 1 week after returning home, and patients transfer to superior hospitals but die within one day.
from hospitaliztion to 1 week after discharge
Secondary Outcomes (4)
in-hospital all cause deaths
from hospitaliztion to 1 week after discharge
a patient level composite score calculated by KPIs of ACS care
During Hospitalization, an expected average of 10 days
each of the 16 KPIs (patient level)
During hospitalization, an expected average of 10 days
a composite of MACE and re-hospitalization due to cardiovascular disease within 6 months after discharge
in 6 months after discharge
Study Arms (4)
Group 1
OTHERGroup 1 will receive quality improvement initiatives first, after 6 months of baseline initiation.
Group 2
OTHERGroup 2 will receive quality improvement initiatives second, after 6 months of the intervention initiation for Group 1.
Group 3
OTHERGroup 3 will receive quality improvement initiatives third, after 6 months of the intervention initiation for Group 2.
Group 4
OTHERGroup 4 will receive quality improvement initiatives forth, after 6 months of the intervention initiation for Group 3.
Interventions
A six component quality improvement intervention will be implemented. These components include: establishment of a quality improvement team, hospital performance audit and feedback, implementation of a clinical pathway, training of physicians and nurses, online technical support and patient education.
Eligibility Criteria
You may qualify if:
- admitted to participating hospitals
- diagnosed as Acute Coronary Syndromes(ACS) at the time of death or discharge
- aged 18 years or older
You may not qualify if:
- death happened within 10 mins after arriving hospital
- ACS happened during hospitalization due to other health problem
- patients already registered in the database
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (102)
Weining hospital
Bijie, Anhui, 553100, China
Lixin people's hospital
Bozhou, Anhui, 236700, China
Woyang people's hospital
Bozhou, Anhui, 236700, China
Wuwei people's hospital
Chaohu, Anhui, 238300, China
Yingshang people's hospital
Fuyang, Anhui, 236200, China
Linquan people's hospital
Fuyang, Anhui, 236400, China
Suixi people's hospital
Huaibei, Anhui, 235100, China
Shucheng people's hospital
Liuan, Anhui, 231300, China
Huoshang hospital
Liuan, Anhui, 237200, China
Zhuanglang people's hospital
Dingxi, Gansu, 730500, China
Gaolan people's hospital
Lanzhou, Gansu, 730200, China
Jingning people's hospital
Pingliang, Gansu, 743400, China
Zhuangliang people's hospital
Pingliang, Gansu, 744600, China
Taishan people's hospital
Jiangmen, Guangdong, 529200, China
Wuhua people's hospital
Meizhou, Guangdong, 514400, China
Lianzhou people's hospital
Qingyuan, Guangdong, 513300, China
Wuchuan people's hospital
Zhanjiang, Guangdong, 524500, China
Pu'an people's hospital
Buwei, Guizhou, 561500, China
Dejiang
Tongren, Guizhou, 565200, China
Yuqing people's hospital
Zunyi, Guizhou, 564400, China
Gaoyang hospital
Baoding, Hebei, 071500, China
Tang county hospital
Baoding, Hebei, 072300, China
Yi county hospital
Baoding, Hebei, 074200, China
Weichang manchu mongolia atounomous county hospital
Chengde, Hebei, 068400, China
Quzhou hospital
Handan, Hebei, 057200, China
Jizhou hospital
Jizhou, Hebei, 053200, China
Qinglong hospital
Qinhuangdao, Hebei, 066500, China
Zanhuang hospital
Shijiazhuang, Hebei, 051200, China
Shenze hospital
Shijiazhuang, Hebei, 052500, China
Pingxiang people's hospital
Xingtai, Hebei, 054500, China
Huaxian people's hospital
Anyang, Henan, 456400, China
Wuzhi people's hospital
Jiaozuo, Henan, 454950, China
Ruyang people's hospital
Luoyang, Henan, 471200, China
Xixia people's hospital
Nanyang, Henan, 474500, China
Chang huan hong li hospital
Xinxiang, Henan, 453000, China
Shangcheng people's hospital
Xinyang, Henan, 465300, China
Dancheng people's hospital
Zhoukou, Henan, 477100, China
Pingyu people's hospital
Zhumadian, Henan, 463400, China
Jianshi people's hospital
Enshi, Hubei, 445300, China
Songzi people's hospital
Jinzhou, Hubei, 434200, China
Danjiangkou's first hospital
Shiyan, Hubei, 442700, China
Tongcheng people's hospital
Xian'ning, Hubei, 437400, China
Gucheng people's hospital
Xiangfan, Hubei, 441700, China
Yidu's first hospital
Yichang, Hubei, 443300, China
Yingcheng people's hospital
Yingcheng, Hubei, 432400, China
Zhongxiang people's hospital
Zhongxiang, Hubei, 431900, China
Ba lin zuo qi people's hospital
Chifeng, Inner Mongolia, 025400, China
A rong qi people's hospital
Hulin, Inner Mongolia, 162700, China
Zha lu te people's hospital
Tongliao, Inner Mongolia, 029100, China
Huolinguole hospital
Tongliao, Inner Mongolia, 029200, China
DongHai people's hospital
Lianyungang, Jiangsu, 222300, China
Dongtai people's hospital
Yancheng, Jiangsu, 224200, China
Gaoyou people's hospital
Yangzhou, Jiangsu, 225600, China
Tongyu people's hospital
Baicheng, Jilin, 137000, China
Linjiang hospital
Baishan, Jilin, 134600, China
Dong feng people's hospital
Liaoyuan, Jilin, 136300, China
Qian'an hospital
Songyuan, Jilin, 131400, China
Huinan people's hospital
Tonghua, Jilin, 135100, China
Changbai montain protection and development zone central hospital
Yanbian, Jilin, 133000, China
Hunchun people's hospital
Yanbian, Jilin, 133300, China
Yitong 1st people's hospital
Yitong, Jilin, 130700, China
Beipiao 1st people's hospital
Chaoyang, Liaoning, 122000, China
Lingyuan people's hospital
Chaoyang, Liaoning, 122500, China
Zhuanghe central hospital
Dalian, Liaoning, 116200, China
Wafangdian people's hospital
Dalian, Liaoning, 116300, China
Kuandian Manchu Autonomous County Central Hospital
Dandong, Liaoning, 118200, China
Qingyuan Manchu Autonomous County people's hospital
Fushun, Liaoning, 113300, China
Beizhen people's hospital
Jinzhou, Liaoning, 122000, China
Changtu people's hospital
Tieling, Liaoning, 112500, China
Fengxiang hospital
Baoji, Shaanxi, 721400, China
Xixiang hospital
Hanzhong, Shaanxi, 723500, China
Mian county hospital
Hanzhong, Shaanxi, 724200, China
Fuping hospital
Weinan, Shaanxi, 711700, China
Hancheng people's hospital
Weinan, Shaanxi, 714200, China
Hu county hospital
Xi'an, Shaanxi, 710300, China
Zichang hospital
Yan’an, Shaanxi, 717300, China
Shenmu hospital
Yulin, Shaanxi, 719300, China
Chengwu people's hospital
Heze, Shandong, 274200, China
Pingyin people's hospital
Jinan, Shandong, 250400, China
Dong'e people's hospital
Liaocheng, Shandong, 252200, China
Yinan people's hospital
Linyi, Shandong, 276300, China
Xintai people's hospital
Tai’an, Shandong, 271200, China
Linqu people's hospital
Weifang, Shandong, 262600, China
Penglai people's hospital
Yantai, Shandong, 265600, China
Huantai people's hospital
Zibo, Shandong, 256400, China
Changzhi steel and iron group head hospital
Changzhi, Shanxi, 046000, China
Qingyuan people's hospital
Changzhi, Shanxi, 046500, China
Hunyuan people's hospital
Datong, Shanxi, 037400, China
Gaoping people's hospital
Jincheng, Shanxi, 048400, China
Lingshi people's hospital
Jinzhong, Shanxi, 031300, China
Pu xian people's hospital
Linfen, Shanxi, 041200, China
Xiangfen people's hospital
Linfen, Shanxi, 041500, China
Guxian people's hospital
Linfen, Shanxi, 042400, China
Yicheng people's hospital
Linfen, Shanxi, 043500, China
Lou fan people's hospital
Taiyuan, Shanxi, 030300, China
Houma people's hospital
Xintian, Shanxi, 043000, China
Yuanping people's hospital
Xinzhou, Shanxi, 034100, China
Huanqu people's hospital
Yuncheng, Shanxi, 043700, China
Dazhu people's hospital
Dazhou, Sichuan, 635100, China
Cangxi people's hospital
Guangyuan, Sichuan, 628400, China
Mianning people's hospital
Liangshan, Sichuan, 615600, China
Xuyong people's hospital
Luzhou, Sichuan, 464400, China
Related Publications (6)
Xie G, Patel A, Du X, Sun Y, Li X, Wu T, Hao Z, Gao R, Wu Y. Impact of In-Hospital Quality of Care Improvement Initiative on Secondary Prevention of Acute Coronary Syndrome in Six Months After Patient Discharge: A Large Stepped Wedge- and Cluster-Randomized Controlled Trial. Circ Cardiovasc Qual Outcomes. 2025 May;18(5):e011441. doi: 10.1161/CIRCOUTCOMES.124.011441. Epub 2025 Apr 4.
PMID: 40184150DERIVEDXie W, Patel A, Boersma E, Feng L, Li M, Gao R, Wu Y. Chronic kidney disease and the outcomes of fibrinolysis for ST-segment elevation myocardial infarction: A real-world study. PLoS One. 2021 Jan 19;16(1):e0245576. doi: 10.1371/journal.pone.0245576. eCollection 2021.
PMID: 33465135DERIVEDSun Y, Feng L, Li X, Gao R, Wu Y. The sex difference in 6-month MACEs and its explaining variables in acute myocardial infarction survivors: Data from CPACS-3 study. Int J Cardiol. 2020 Jul 15;311:1-6. doi: 10.1016/j.ijcard.2020.03.043. Epub 2020 Mar 20.
PMID: 32223960DERIVEDFeng L, Li M, Xie W, Zhang A, Lei L, Li X, Gao R, Wu Y. Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China. BMJ Open. 2019 Nov 10;9(11):e031918. doi: 10.1136/bmjopen-2019-031918.
PMID: 31712344DERIVEDWu Y, Li S, Patel A, Li X, Du X, Wu T, Zhao Y, Feng L, Billot L, Peterson ED, Woodward M, Kong L, Huo Y, Hu D, Chalkidou K, Gao R; CPACS-3 Investigators. Effect of a Quality of Care Improvement Initiative in Patients With Acute Coronary Syndrome in Resource-Constrained Hospitals in China: A Randomized Clinical Trial. JAMA Cardiol. 2019 May 1;4(5):418-427. doi: 10.1001/jamacardio.2019.0897.
PMID: 30994898DERIVEDLi S, Wu Y, Du X, Li X, Patel A, Peterson ED, Turnbull F, Lo S, Billot L, Laba T, Gao R; CPACS-3 investigators. Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China. Am Heart J. 2015 Mar;169(3):349-55. doi: 10.1016/j.ahj.2014.12.005. Epub 2014 Dec 18.
PMID: 25728724DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Yangfeng Wu, PhD
George Institute for global health, China
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- senior director
Study Record Dates
First Submitted
July 18, 2011
First Posted
July 20, 2011
Study Start
September 1, 2011
Primary Completion
December 1, 2014
Study Completion
June 1, 2015
Last Updated
August 10, 2016
Record last verified: 2016-08