Quality markers in cardiology: measures of outcomes and clinical practice—a perspective of the Spanish Society of Cardiology and of Thoracic and Cardiovascular Surgery

The complexity of the individual patient and organization of medical practice results in important institutional and country quality of care variability.1–17 Attempts to assess the quality of clinical practice have established rating systems that may yield completely different results and rating for the same hospital during the same period of time, adding confusion rather than help to prove their usefulness and, questioning whether existing measures can actually measure quality.18–35 Most important, benchmarking may be associated with progressive improvement both in performance and outcomes,18,26,28,36–38 highlighting the relevance of standardization of quality measures and the responsibility of scientific societies. The Spanish Society of Cardiology (SSC) and the Spanish Society of Thoracic and Cardiovascular Surgery (SSTCS) organized a task force to identify and define two sets of quality metrics in hospital cardiology practice: (i) outcome measures (metrics of the final quality of the practice of cardiology) and (ii) performance measures (metrics of clinical practice which are known to positively influence desirable outcomes). Beyond this objective, Scientific Societies and Health Care Authorities should be responsible for the implementation of programmes to measure quality, ensure the quality of the data, benchmarking, and certification/accreditation of cardiology services. All European Society of Cardiology (ESC)32 and American Heart Association/American College of Cardiology33 guidelines were reviewed and recommendations related to quality standards were included in the document. ### Grading of quality markers Three levels were established both for class recommendation and level of evidence considering (i) clinical and practical …