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A revolution is under way in the field of cardiovascular medicine. Our community is witnessing seismic shifts in who we are, what we do, and why we do it. For years providers have focused on being the most able practitioners and researchers they can be, because of an unshakeable conviction that an informed physician provides better care to their patients. This issue of US Cardiovascular Disease will provide both the physician reader and other cardiovascular care stakeholders with a wealth of cutting-edge information on the diagnostic and therapeutic tools available and in development, covering every conceivable aspect of cardiovascular care.

However, even as we struggle to digest the flood of knowledge, we are also learning that 'being informed' is not enough. Reports of widespread medical errors have grabbed national attention. The gap between knowledge and practice is increasingly well recognized, and it is significant. It is also clear that addressing this gap is an urgent issue that will demand the participation and contribution of every single stakeholder involved in healthcare and every reader of this volume. Fortunately, many professional organizations are taking up the challenge on behalf of their members and, ultimately, to the benefit of patients. The American College of Cardiology (ACC) is one of those consistently at the forefront of the battle nationally.

Achieving quality in cardiovascular medicine is difficult, but necessary. Efforts clearly include education and knowledge as a core component, hence the great value of the reviews and surveys contained here. However, in addition to creating and deploying knowledge, we must develop the tools and systems needed to achieve measurable quality in cardiovascular healthcare on a consistent basis.

As you read the monographs and essays, think about how one might distill the information into five to 10 simple points that the cardiovascular practitioner must apply in his or her practice; then think how you can help in ensuring that these get carried out properly for every patient, every time. Research has shown that increases in adherence to evidence-based medicine are associated with a commensurate reduction in mortality.We cannot afford to ignore the power and importance of such efforts for our clinical enterprise and for our patients.

Quality is a process. It is clear we will never bridge the perhaps infamous but important Institute of Medicine 'Quality Chasm' without systems to support this work. Physicians cannot do this alone. The quality revolution, powerful as it is, does not occur in a vacuum. But it starts with each of us, in our own day to day practices and professions, helping our community to do the right thing, for the right patient, at the right time.

As William James, an American philosopher, psychologist, and leader of the pragmatist movement, said: "The greatest revolution of our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives."

Let us, then, take up the quality challenge.We all can be revolutionaries.We must change our inner attitudes to match our outer aspects when it concerns quality. Let the revolution begin!