In an editorial in the journal, Ori Ben-Yehuda, MD, FACC from the University of California in San Diego, wrote that "the GAP project is an important step in the long road toward quality in medicine in general and cardiology in particular."

"Education is not enough. We need systems and checklists, "reminder tools;" just as pilots rely on checklists. The study in the Journal points to the efficacy of such tools in increasing compliance. Given recent trials which demonstrate that we need to be even more aggressive with cholesterol lowering, for example, in patients who have had a heart attack, the imperative of closing treatment gaps becomes even more urgent, and at the same time more difficult to achieve (because we now need even greater cholesterol reduction than before)," Dr. Ben-Yehuda said.

He added that the GAP project demonstrates the commitment of the ACC and the cardiology community to quality improvement.

Gregg C. Fonarow, MD, FACC at the University of California in Los Angeles, who has been deeply involved in quality improvement efforts, but was not connected with this study, said tens of thousands of lives could be saved each year if all hospitals used programs such as GAP.

"This study provides further evidence that a substantial proportion of patients receiving conventional care for acute coronary syndromes are discharged without evidenced-based, guideline recommended, life-prolonging therapies. As demonstrated in this study, use of simple reminder tools for clinicians such as preprinted orders and discharge checklists resulted in significant improvements in treatment rates," Dr. Fonarow said.

The American College of Cardiology, a 29,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

acc