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rates were 23.4 percent for myocardial infarction, 21.1 percent for unstable angina, 13 percent for heart failure 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 country," Dr. Krumholz says. "Over the last decade, hospitals, doctors, professional societies and the government have all worked together to make sure the quality of care is increas- ing. 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 com- munication and a focus on implementation." 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 significant 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 flagship initiative launched in 1999 that is designed to help clinicians and hospitals deliver evidence- based therapies Get with the Guidelines provides hospi- tals with a web-based patient management tool, best practice discharge protocols and standing orders, along with a robust registry and real-time benchmarking capabilities to track performance. Local MVPs "We know that outcomes improve when we apply the Guidelines correctly," says William Lewis, MD, Chief of Cardiology and Director of the Heart & Vascular Center at MetroHealth Medical Center in Cleveland. Dr. Lewis is also a member of the National Steering Committee for the AHA's Get with The Guidelines program. "When we look at MetroHealth's heart failure measures for 2014, they're at 100 percent, because we focused like a laser beam on them. The end result is people are surviving cardiovascular disease and living longer." MetroHealth has been a Gold Plus Performance Achievement Award recipient in the Get with the Guidelines heart failure and stroke programs since 2005. Last year, the medical center was the first in the nation to receive a Get with the Guidelines award in atrial fibrillation. Dr. Lewis chairs the AHA national steering committee which developed the guidelines for this program. "MetroHealth entered the Get with the Guidelines atrial fibrillation program at its inception and made it a priority," Dr. Lewis explained. "Someone with atrial fibrillation is five times more likely to have a stroke than someone who does not have atrial fibrillation. And about 40 percent of patients who have atrial fibrillation need a blood thinner but 2 0 1 5 M A R C H /A P R I L ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 7