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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:825-31 - Vol. 70 Num.10 DOI: 10.1016/j.rec.2016.12.043

Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome

Ana de Lorenzo-Pinto a,b,, Ana Herranz-Alonso a,b, Begoña Cuéllar-Basterrechea a,b, José María Bellón-Cano b,c, María Sanjurjo-Sáez a,b, Héctor Bueno d,e,f

a Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Unidad de Metodología y Bioestadística, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Cardiología e Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
e Grupo de Investigación Multidisciplinar Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
f Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

Refers to

Initiatives to Achieve Excellence in the Care of Acute Coronary Syndrome
Íñigo Lozano, Juan Rondán, José M. Vegas, Eduardo Segovia
Rev Esp Cardiol. 2017;70:1026-7
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Cost-effectiveness. Quality improvement. Bleeding. Safety. Acute coronary syndrome. Antithrombotic treatment.


Introduction and objectives

To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy.


We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions.


A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P = .20). The estimated avoided cost was €95 113.6 per year, meaning that €10.1 would be obtained in return for each euro invested during the first year and €36.3 during the following years.


This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive.


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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved