American College of Cardiology

October 1, 2000

American College of Cardiology—Leading the Way in Addressing the Nation's Quality of Care

Thirteen of the 24 measures discussed in the report are cardiovascular-related, addressing conditions such as acute myocardial infarction (heart attack), heart failure, and diabetes. More specifically, the quality measurements include data as to whether aspirin was administered to heart attack patients within 24 hours of admission, and if heart attack patients who smoked were counseled on smoking cessation while in the hospital.

The report of these new data will appear in the Oct. 4, 2000, issue of the Journal of the American Medical Association.

"Across the nation, the cardiovascular-related results are uneven," said Dr. Kim Eagle, chair of the American College of Cardiology (ACC)/American Heart Association (AHA) Joint Task Force on Performance Measures, and the principal investigator on the Guidelines Applied in Practice (GAP) Project—the ACC's most recent initiative to bring guidelines to the point-of-care. "The results show that many states are doing well, but there is definitely a need to continue to work for overall improvement."

The ACC has long been involved in promoting quality cardiovascular care for the improvement of public health. "The ACC is committed to improving the quality of cardiovascular care, and studies like this one clearly show that we need to go well beyond distilling scientific evidence into guidelines or more traditional continuing medical education. We have to think about how guidelines can be translated into tools that are useful at the point of service and about how to bring those tools into everyday practice. We also need to provide ways for health care providers to effectively measure the quality of the care that they are delivering so that they can identify and address aspects that need improvement. The College is appropriately taking a leadership role in performance measurement and in guideline implementation," said Dr. Eagle.

Several initiatives are currently in place at the ACC, some recent and some longstanding, and all demonstrating the ACC's commitment to improving the quality of cardiovascular care. These initiatives include 1) the GAP Project, 2) the work of the ACC/AHA Joint Task Force on Performance Measures, 3) the ACC-National Cardiovascular Data Registry™'s (ACC-NCDR™), and 4) the continuing development and updating of ACC/AHA clinical practice guidelines.

The initial GAP Project, now in its ninth month, has partnered with 10 hospitals in southeast Michigan to participate in the project. The investigators hope to improve the care of patients having a heart attack by increasing adherence to the key recommendations of the ACC/AHA's recently updated guidelines on heart attack. The lead investigators are also looking at ways the College can make clinical guidelines easier to use and, therefore, more effective. Evidence-based tools, such as pocket guidelines and patient information forms, are being used by physicians, nurses, and even patients in the project for reference during the course of a patient's care. Results are expected to be announced at the ACC's Annual Scientific Session in Orlando next March. The next GAP Project, which will begin in November at the AHA's annual meeting, is already recruiting interested hospitals and health care organizations.

The ACC/AHA Joint Task Force on Performance Measures, established in March of this year, is developing measures that health care providers can use to gauge the quality of the care they give to their patients, identify areas for improvement, and track their progress. The task force has created two writing groups to develop performance measurement sets—one on heart attack and one on heart failure. These two sets are scheduled for publication in the fall of 2001, and other important areas will follow.

The ACC-NCDR™, which to date has enrolled more than 300 hospitals and currently has data on more than 225,000 patients across the United States, provides comparative data for quality assessment and improvements in cardiovascular care. The ACC-NCDR™ is also aligning its definitions with other cardiovascular data registries. These shared data elements will reduce redundant data collection and assist when, for example, patients need to be included in more than one registry.

ACC/AHA evidence-based practice guidelines are also intended to assist physicians in quality clinical decision making by providing recommendations for practice based on expert interpretation of the best medical evidence available. The guidelines describe a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions and categorize recommendations both according to the strength of opinion behind them and the level of evidence supporting them. This year, clinical practice guidelines on unstable and stable angina (chest pain) have been published, and many more are in development. To date, the ACC has available 17 published clinical practice guidelines, including topics such as valvular heart disease and coronary artery bypass graft surgery.

The American College of Cardiology, a 25,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

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