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MOST VALUABLE PLAYERS THE SIGNIFICANT DECLINES in mortality and hospitalization rates for cardiovascular diseases represent the joint efforts of, among others, hospital clinicians, the Centers for Medicare & Medicaid Services, the American Heart Association (AHA), American Stroke Association and the American College of Cardiology to streamline care and implement evidence-based standards. While the cardiovascular trends study was not designed to pinpoint the reasons for outcome improvement, factors believed to play signifi cant roles include: + Patient education about heart attack and stroke warning signs and about the role of smoking and other lifestyle factors in cardiovascular disease development + The AHA's Get with the Guidelines Program, a fl agship initiative launched in 1999 that is designed to help clinicians and hospitals deliver evidence-based therapies we can't claim special credit," Dr. Krumholz explains. "We can just say this is representa- tive of all other conditions. We wanted to make that comparison." 'Breathtaking' Results Resea rchers were a stounded by their fi ndings. Rates of hospitalization during the years covered by the study declined 38 percent for patients with myocardial infarction, 30.5 percent for patients with hea r t fa ilure a nd 33.6 percent for those with ischemic stroke. The largest decline, however, occurred in the area of unstable a ngina, which saw a n 83.8 percent reduction in hospitalization rates. By comparison, the decline in hospitalization rates across all other conditions averaged 10 percent. Thirty-day readmission rates experi- enced the following declines: 18.6 percent for myocardial infarction, 32.3 percent for unstable angina, 9.7 percent for heart failure and 5.9 percent for ischemic stroke. Mortality rates after 30 days decreased nearly 30 percent for myocardial infarc- tion, 13.1 percent for angina, 4.7 percent for stroke and 16.4 percent for heart failure. Observed declines in one-year mortality rates were 23.4 percent for myocardial infarction, 21.1 percent for unstable angina, 13 percent for heart fail- ure and 13.1 percent for ischemic stroke. "Between 1996 and 1997, we began to fully appreciate that even though we were generating good evidence, it was being unevenly applied across the coun- try," Dr. Krumholz says. "Over the last decade, hospitals, doctors, professional societies and the government have all worked together to make sure the qual- ity of care is increasing. The results are breathtaking — truly remarkable — and I think it shows they can be translated into other areas of medicine. We've made extraordinary progress, and it's not due to an extraordinary medicine. We've done it because of better care, better communication a nd a focus on implementation." ■ M D N E W S . CO M ■ MD NEWS San Antonio | 1 3