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LO O K I N G TO T H E F U T U R E TO BUILD UPON the success in cardiovascular disease trends, the American Heart Association (AHA) and American Stroke Association are launching the Target: Stroke Phase II initiative — focused on increasing the speed at which the clot-dissolving drug tPA is administered to ischemic stroke patients — in early 2015. The AHA also plans to expand the Mission: Lifeline program to improve the timeliness of the response to patients having heart attacks. "The challenge ahead is to build upon these positive trends," says Gregg C. Fonarow, MD, Co-Chief of the University of California, Los Angeles, Division of Cardiology and former chair of the Steering Committee for the AHA's Get with the Guidelines Program. "Ultimately, we want to remove cardiovascular disease and stroke from among the top rates of death. We have made tremendous gains, but it will take new efforts to ensure that new therapies are developed and broadly implemented." FOR MOST OF THE 21ST CENTURY, CARDIOLOGY PRACTICE HAS FOCUSED ON IMPROVING THE QUALITY OF CARE AND IMPLEMENTING EVIDENCE-BASED CLINICAL GUIDELINES. A STUDY SUGGESTS THOSE EFFORTS HAVE YIELDED A STRING OF REMARKABLE SUCCESSES. P UBLISHED IN CIRCULATION in late 2014, the study, "Trends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke: 1999-2011," reviewed data regarding myocardial infarction, unstable angina, ischemic stroke and heart failure. Researchers examined mortality and hospital readmission rates, among other factors, for these conditions in all individu- als age 65 and older who participated in the Medicare fee-for-service program. Results revealed signifi cant improvements in outcomes, as evidenced by declining trends in mortality and hospitalization. A Measure of Success The goal of the research was to evaluate what had been achieved during a period when there were not many therapeutic breakthroughs for stroke and cardiovas- cular disease but rather an emphasis on quality and the translation of evidence to the bedside, according to Harlan M. Krumholz, MD, Director of the Center for Outcome Research and Evaluation at Yale University School of Medicine and lead author of the study. Researchers evaluated medical records for nearly 34 million Americans receiving Medicare. Key factors considered for the four diagnoses included hospitalization rates, mortality rates at 30 days and one year post-hospitalization, and 30-day hospital readmission rates. "To really measure the benefi ts of our work in trying to improve care, we have to look at what's happening with the patients ...," Dr. Krumholz says, "so we tried to focus on the patient experience." Analyzing data from such a broad pool of Medicare patients gave researchers an advantage over smaller studies that seek to quantify the national experience. They were able to produce a report card refl ective of national trends that not only outlined progress in cardiology but also allowed for comparisons between some of the trends observed in cardiology and those seen in other medical specialties. "If we decreased the [hospitalization] rates to the same extent as other specialties, By Tiffany Parnell ON IMPROVING THE QUALITY OF CARE AND IMPLEMENTING EVIDENCE-BASED ON IMPROVING THE QUALITY OF CARE AND IMPLEMENTING EVIDENCE-BASED in Cardiovascular Outcomes Research Finds 'Extraordinary Progress' 1 2 | San Antonio MD NEWS ■ M D N E W S . CO M