Advancing Research, Applying Knowledge, Improving Healthcare Quality

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Perception often lacks reality, and for many cardiologists and other physicians, the image and understanding of the nation's premier private organization dedicated to the prevention and treatment of heart disease and stroke is woefully out of date. For many physicians, the mission of the American Heart Association (AHA) is simply research, education, and advocacy, but it is much more than that. Since its founding in 1924 by a group of six cardiologists, the AHA has evolved into a multidimensional organization that emphasizes a three-pronged strategy to advance the prevention and treatment of heart disease and stroke.This strategy is much like the proverbial three-legged stool - advancing research, applying knowledge, and improving healthcare quality. If any of the legs gets short-changed, the stool or strategy will become ineffectual. Heart disease, stroke, and other cardiovascular diseases remain the leading killers in the US, causing almost 950,000 deaths annually. About 63 million Americans suffer from some form of these diseases. In 2002, cardiovascular diseases cost the nation an estimated US$350 billion in medical expenses and lost productivity.

Research Fuels the Mission

Medical research into preventing and treating heart disease and stroke fuels the AHA's mission to reduce disability and death from these diseases. Research is also the core of its public and professional educational programs. Consequently, funding research remains a top priority. The AHA is second only to the National Institutes of Health (NIH) in non-industry spending for heart and stroke research. In fiscal year 2003, the organization invested US$135.3 million to fund meritorious research projects - more than 25% of its annual expenses.

To maintain the flow of research advances, the AHA provides a continuum of support to help talented researchers build their careers. Pre-doctoral research fellowships help students conduct research before receiving their PhD or MD; post-doctoral fellowships provide research training and mentorship.The Fellow-to- Faculty Transition Award gives physician-scientists vital research time and resources to obtain research training and to establish investigative careers that will ensure continued medical advances.

The Scientist Development grant helps new scientists develop into independent, productive researchers. The Established Investigator Award recognizes past accomplishment and helps an investigator to achieve the promise of future discoveries. Beginning Grants-in-Aid and Grants-in-Aid round out the AHA's research offerings.

The fruits of research, however, have little impact unless physicians and others know about the findings. The organization also supports research by disseminating late-breaking knowledge through its respected scientific journals, councils, interdisciplinary working groups, and scientific sessions. More than 27,000 attended the AHA's 76th Scientific Sessions in Orlando, and more than 3,500 abstracts were presented in basic, clinical, and population science. Scientific Sessions 2004 will focus on advancing research, applying knowledge, and improving healthcare.

Core Strategy - Improving Patient Outcomes

The AHA's support for medical research is well known. Less visible, perhaps, is the organization's commitment to improving patient outcomes. The AHA's 2010 Strategic Plan commits the AHA to

"mobilize relationships that maximize the discovery, process and transfer of knowledge applied to improving quality cardiovascular health outcomes for patients"

The organization is in a unique position to develop, process, and translate the best available science into practical applications for healthcare systems and providers, and then steer the use of those practical applications into the healthcare marketplace where they ultimately affect patient care. Because of its reputation and impartiality, the AHA makes a special contribution in this arena. In this process, the organization seeks to continually raise the bar on quality of patient care - through advocacy and creating systems, programs, and partnerships that ensure that AHA guidelines become the standard for patient care.

The primary underpinnings of quality for the association are discovery, translation, and implementation, and all are linked.

  • Discovery - the quality process begins with the discovery and cultivation of science associated with cardiovascular disease and stroke through support for research.
  • Translation - as an extension of discovery, the science that results from research is further translated into guidelines for specific disease states and/or procedures, performance measures, clinical data standards, and a health policy that influences the healthcare system.
  • Implementation - with the development of clinical guidelines and performance standards, programs and activities are developed to facilitate the implementation and adoption of the guidelines and measures in actual healthcare settings.

Studies show that improving the quality of care that heart disease and stroke patients receive could save thousands of lives each year. Consequently, the AHA has developed and begun to implement several initiatives aimed at improving the quality of patient care.

Get With The GuidelinesSM (GWTG) is a hospital-based program designed to ensure that patients are consistently treated and discharged according to evidence-based guidelines for coronary artery disease (CAD) and stroke. The quality improvement program empowers healthcare teams to save lives and reduce healthcare costs by providing training and staffing recommendations so that hospitals can create an infrastructure and multidisciplinary teams, providing implementation tools, such as a Web-based, realtime patient management tool that complies with reporting requirements, facilitating best practices discussion among participating hospitals, and providing customized patient education materials.The program has two modules - GWTG-Coronary Artery Disease (GWTG-CAD) and GWTG-Stroke.

Since its launch in 2001, more than 400 hospitals are participating in GWTG-CAD and more than 100,000 patient records have been entered into the GWTG-CAD patient management tool database. This program alone has the potential to save 80,000 lives annually if fully implemented nationwide. GWTG-CAD focuses on interventions, such as smoking cessation, lipid-lowering therapy, angiotensin-converting enzyme (ACE) inhibitor use, blood pressure treatment, beta-blocker use, weight and exercise management, and diabetes management. Studies show that GWTG-CAD implementation significantly improves compliance in key indicators.

GWTG-Stroke, launched in early 2004, provides tools and hospital protocols consistent with guidelines for treating stroke. Modeled after its successful counterpart GWTG-CAD, GWTG-Stroke had more than 200 hospitals participating and more than 47,000 patients entered into the GWTG-Stroke patient management tool. Preliminary results from the aggregate data show improvement across all performance measures. In acute stroke treatment, the program measures time of symptom onset, time from emergency medical services (EMS) receiving a call to EMS arrival, time patient arrived at emergency department, time of computed tomography (CT)/magnetic resonance imaging (MRI) scan, and time of thrombolytic therapy. For secondary stroke prevention, the program measures smoking cessation counseling, lipid-lowering therapy, weight and exercise management, diabetes management, atrial fibrillation (AF) management, and alcohol management.

An excellent precursor for GWTG-Stroke, the Acute Stroke Treatment Program provides a step-by-step tool kit that helps hospitals and healthcare professionals apply the Brain Attack Coalition's recommendations for establishing primary stroke centers. The Brain Attack Coalition consists of key stroke organizations representatives across the US, including the American Stroke Association (ASA), a division of the AHA.

To complement the Acute Stroke Treatment Program and GWTG-Stroke, the ASA collaborated with the Joint Commission on Accreditation of Healthcare Organizations to develop a Primary Stroke Center Certification Program.The program recognizes sites that demonstrate compliance with clinical practice guidelines to manage and optimize care, and document performance measurement and improvement activities.The Heart and Stroke Recognition Program, the AHA/ASA's collaborative effort with the National Committee for Quality Assurance, recognizes physicians or physician groups who demonstrate high levels of performance in cardiovascular and stroke care. This program identifies physicians who consistently provide important screenings and work effectively with patients to control such key risk factors as high blood pressure and high cholesterol levels.

The association's Emergency Cardiovascular Care Programs educate healthcare providers, care-givers, and the general public about how to respond to cardiovascular emergencies, including cardiac arrest, heart attack, and stroke. Annually, these programs train more than eight million people in topics ranging from basic cardiopulmonary resuscitation (CPR), the use of automated external defibrillators (AEDs) and first aid to advanced cardiac life support and pediatric advanced life support. The association develops Emergency Cardiovascular Care (ECC) Guidelines that serve as the standard for both ECC programs and US training organizations, and are used in more than 66 countries.