title: The importance of consistent, high-quality acute myocardial infarction and heart failure care results from the American Heart Association's Get with the Guidelines Program.
abstract: OBJECTIVE
  This study examined the degree to which hospital performance for acute myocardial infarction (AMI) and heart failure (HF) care processes are correlated.
  
  
  BACKGROUND
  Although AMI and HF care processes may be amenable to similar quality improvement interventions, whether these are indeed correlated and whether hospitals with consistently superior performance for both care metrics have the best outcomes remains unknown.
  
  
  METHODS
  We compared hospital performance of the Centers for Medicare & Medicaid Services AMI and HF core measures in 283 hospitals submitting 10 or more patients to the Get With The Guidelines AMI and HF programs between January 2005 and April 2009.
  
  
  RESULTS
  Median hospital adherence to AMI and HF composite measures were 93% (interquartile range: 87% to 97%) and 92% (interquartile range: 85% to 96%), respectively, with only a modest correlation between hospital performance on these 2 composite metrics (r = 0.50; 95% confidence interval: 0.41 to 0.58). Hospitals with superior performance to both AMI and HF processes had significantly longer duration of Get With The Guidelines participation and lower adjusted in-hospital mortality (odds ratio: 0.79; 95% confidence interval: 0.63 to 0.99) for AMI and HF patients, whereas hospitals with superior adherence to either alone had similar mortality rates as hospitals with superior adherence to neither measure.
  
  
  CONCLUSIONS
  Hospitals that had consistent, superior performance for both AMI and HF care had significantly lower risk-adjusted mortality than those with superior performance either alone or for neither measure. Whether a single scoring system to assess global, rather than condition-specific, quality of cardiovascular care would facilitate care quality improvement more consistently and would optimize patient outcomes merits further investigation.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina, USA. tracy.wang@duke.edu
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D002309:Cardiology / Q000379:methods*; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015397:Program Evaluation; D011786:Quality Control; D012042:Registries; D012306:Risk; D016896:Treatment Outcome; D014481:United States