Journal of the American Heart Association
October 16, 2026 · via Europe PMC
Effectiveness of Discrete Strategies and Implementation Bundles for Improving Clinician Prescription of Clinical Practice Guideline-Recommended Medications for Atherosclerotic Occlusive Disease: A Systematic Review and Meta-Analysis.
Kirkham AM, Candeliere J, Presseau J, McIsaac DI, Shorr R, Fergusson DA, Roberts DJ
AI summary — for doctors, generated from the abstract only
Multicomponent implementation bundles, and team changes in particular, improved clinicians' prescribing of guideline-recommended medications in atherosclerotic occlusive disease, with some signals of better patient outcomes.
What was studied
Systematic review and random-effects meta-analysis of randomized trials (databases searched to December 9, 2025) of discrete strategies and implementation bundles to improve prescribing of strongly recommended guideline medications in adults with atherosclerotic occlusive disease, with GRADE certainty ratings.
Key findings
- 31 randomized trials covering 29 unique strategies and bundles were included.
- The bundle combining case management, team changes, continuous quality improvement, audit/feedback, and clinician and patient education had the largest effect (relative risk 2.62, 95% CI 2.08-3.29; moderate certainty).
- Team changes alone improved prescription of all strongly recommended medications (relative risk 1.23, 95% CI 1.11-1.36; moderate certainty) and reduced major adverse cardiac events.
Clinical relevance
Health systems seeking to close prescribing gaps can prioritize team-based care and multicomponent bundles over single interventions such as education alone.
Who should care
Limitations
The abstract does not report certainty for the outcome findings, and the bundles and strategies were heterogeneous. Results on death and vascular events apply to specific bundles that may be based on few trials.
Team-based, multicomponent quality improvement is the most effective way identified to get guideline medications prescribed in these patients.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
We sought to determine the effectiveness of discrete strategies and implementation bundles for improving clinical practice guideline (CPG) strongly recommended medication prescription to adults with atherosclerotic occlusive disease.
METHODS
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (inception to December 9, 2025) for randomized controlled trials evaluating discrete strategies or implementation bundles for improving CPG strongly recommended medication prescription to adults with atherosclerotic occlusive disease. Two investigators screened titles/abstracts and full texts, extracted data, assessed risk of bias, and classified discrete strategies and implementation bundles. Random-effects models were used for meta-analysis. Grading of Recommendations Assessment, Development and Evaluation was used to assess certainty.
RESULTS
We included 31 randomized controlled trials studying 29 unique discrete strategies and implementation bundles. The implementation bundle with the largest effect size for improving CPG strongly recommended medication prescription combined case management, team changes, continuous quality improvement, audit/feedback, and clinician and patient education (relative risk, 2.62 [95% CI, 2.08-3.29]; moderate certainty). Meta-regression analyses suggested that discrete strategies and implementation bundles using patient education were more effective at improving statin (=0.037) and all CPG strongly recommended medication (=0.006) prescription. Combining case management, team changes, facilitated relay of information, and audit/feedback reduced all-cause death and new vascular event risk. Team changes improved prescription of all CPG strongly recommended medications (relative risk, 1.23 [95% CI, 1.11-1.36]; moderate certainty) and reduced major adverse cardiac event risk.
CONCLUSIONS
Combining case management, team changes, continuous quality improvement, audit/feedback, and clinician and patient education had the largest effect size for improving CPG strongly recommended medication prescription and improved patient outcomes. Team changes improved CPG strongly recommended medication prescription and reduced major adverse cardiac event risk.
DOI
10.1161/JAHA.126.052304
PMID
42885780
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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