Bleeding is the most common complication of the percutaneous coronary intervention (PCI) procedure performed for treating blocked heart arteries. It is life threatening, painful, and very costly. It increases patients'risk of short- ad long-term mortality. Thus, there is an urgent and critical need to reduce bleeding and to make PCI safer. Bleeding is predictable and modifiable, and validated risk-prediction models can accurately quantify a patient's risk before bleeding occurs. If bleeding risk is known, a patient-centered approach that targets at-risk patients with several highly effective bleeding avoidance therapies (BATs) can be used. However, BATs are currently used inconsistently, particularly among patients with the highest risk of bleeding, showing a clear risk-treatment paradox. Our goals are to reverse the risk-treatment paradox and to reduce bleeding by implementing a patient-centered, safe practice intervention at Washington University, Barnes Jewish Hospital in St. Louis, MO. We propose to: 1) Implement a novel, nurse-led, health information technology solution to translate a risk-prediction model, predict bleeding risk and explicitly bring bleeding risk to the physician's attention via a decision aid. The decision aid will encourage patient-centered and evidence-based use of bleeding avoidance therapies in at-risk patients. We will reinforce a permanent change in physician practice by providing daily and monthly audit and feedback reports until the desired patient-centered use of bleeding avoidance therapies is achieved. 2) We will measure the impact of the patient-centered approach. We will compare PCI bleeding outcomes and bleeding avoidance therapies use from the year preceding and the year after the intervention with a quasi-experimental design. 3) We will create an implementation toolkit and disseminate our patient-centered bleeding reduction strategy to stakeholders. We are confident that a patient-centered approach at the bedside will enable physicians to make clear, well-informed decisions that will result in the risk-aligned use of effective bleeding avoidance therapies. Our long-term goal is to change standard reactive patient management into proactive patient management, which will result in a critical paradigm shift in the clinical treatment of PCI related bleeding.

Public Health Relevance

Bleeding is a life-threatening complication of the commonly performed angioplasty procedure. We propose to use a patient-centered approach in using bleeding avoidance therapies to reduce bleeding complications and increase the safety of angioplasty.

National Institute of Health (NIH)
Research Demonstration and Dissemination Projects (R18)
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Opstal, Marcy
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Washington University
Internal Medicine/Medicine
Schools of Medicine
Saint Louis
United States
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