Overview of the American Heart Association "Get with the Guidelines" programs: coronary heart disease, stroke, and heart failure.

Despite recent advances in scientific knowledge about and improvement of treatment and prevention (primary and secondary) for heart disease and stroke, these conditions remain the number one and 3 causes of death in the United States. Every year, there are nearly 500,000 deaths from coronary heart disease and over 160,000 from stroke in the country. An estimated 700,000 Americans have new coronary heart disease (CHD) every year and an additional 500,000 have recurrent CHD events. The corresponding numbers for stroke are 500,000 and 200,000. The burden of heart failure in the society is also substantial. Deaths attributable to heart failure as the primary or secondary cause total 265,000 per year. In addition, there are one million annual heart failure discharges from hospitals. The combined annual direct and indirect cost for CHD, stroke, and heart failure exceeds $225 billion. This enormous burden of disease is also associated with numerous data collection efforts in hospitals to assess the quality of care delivered in coronary artery disease (CAD), heart failure, and stroke. These include the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) ORYX and the Centers for Medicare & Medicaid Services (CMS) measure sets for acute myocardial infarction and heart failure, the National Registry of Myocardial Infraction, GRACE for acute coronary syndromes, The Paul Coverdell National Acute Stroke Registry, and ADHERE for heart failure. Table 1 presents data from several of these sources that demonstrate, despite wide dissemination of these guidelines, recommended interventions are frequently not initiated during hospitalization for acute cardiac events, heart failure, and stroke.