Should We Measure Quality by the Dose?∗

J Am Coll Cardiol: November 5, 2013

Quality improvement has become a standard component of clinical care over the past decade—and it has led to dramatic improvements in care. Looking back, in 2001 Fonarow et al. 1 reported that the use of statins following myocardial infarction was a very disappointing 31.7%. This and other observations of very low use of therapies well documented to improve outcomes—such as aspirin, statins, and beta-blockers—spurred the development of large-scale registries and quality-improvement programs to increase the use of these life-saving agents. Great successes have been seen with these programs, which include CHAMP (Cardiac Hospitalization Atherosclerosis Management Program) 2, GAP (Guidelines Applied in Practice) (3), Get With the Guidelines 4, CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) 5, GRACE (Global Registry of Acute Coronary Events) 6, ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry 7, and REACH (Reduction of Atherothrombosis for Continued Health) Registry (8). Over time, use of each of these agents has improved to >90%. Read More