The American College of Cardiology - Quality in Action

Login or register to view PDF.

Initially, the American College of Cardiology accomplished its mission of improving cardiovascular care through its educational programs, but over the past 30 years the College’s quality journey has included the production of performance measures, data standards, and appropriate use criteria (AUC). In addition, the College established the National Cardiovascular Data Registry® (NCDR) to provide data to support quality improvement. This was followed by a number of ambitious quality improvement programs such as the Guidelines Applied in Practice (GAP), Door to Balloon (D2B), and Hospital to Home (H2H) initiatives. In response to healthcare reform, the College is now supporting its members with patient-centered programs aimed at increasing the value of healthcare, including application of AUC to imaging, voluntary public reporting of cardiac catheterization laboratory performance, and practice-level improvement programs using NCDR data and supporting maintenance of certification. The College has launched the PINNACLE Network™ to help cardiovascular practices thrive in the new healthcare market and as a platform for implementing its quality improvement initiatives.

The author has no conflicts of interest to declare.
Joseph P Drozda, Jr, MD, FACC, Mercy Health Research, 12680 Olive Boulevard, Suite 200, St Louis, MO 63141. E: Joseph.Drozda@Mercy.Net
Received date
15 July 2010
Accepted date
21 July 2010


Since its foundation six decades ago, the goal of the American College of Cardiology (ACC) has been to improve the quality of cardiovascular care. The College’s founders initially sought to accomplish this goal by providing the College’s members with access to high-quality educational opportunities such as the ACC’s highly successful annual scientific sessions. In 1984, the quest for improved care of the cardiac patient took a new direction when the College and the American Heart Association (AHA) issued their first clinical practice guideline on the appropriate use of cardiac pacemakers “because of allegations of abuses of this technology.”1 This was an ironic turn from two standpoints. First, the guidelines were created in response to a cost and utilization concern, foreshadowing the College’s attempts to address similar concerns during the healthcare reform efforts in the Clinton years and again recently as the healthcare reform legislation convulsed its way through Congress and was ultimately passed into law. Second, the pacemaker guidelines could arguably be said to have been the ACC’s first set of appropriate use criteria (AUC)—a program that was not formally launched as such until 2005 with the publication of the first AUC sets. As described by the task force that developed that first set of guidelines, the task force was “formed to make recommendations regarding the appropriate utilization of technology in the diagnosis and treatment of patients with cardiovascular disease.”1 With that as a starting point, the ACC embarked on a new strategy for supporting and promoting clinical quality improvement—a strategy that continues to evolve based on member and societal needs.

Quality Improvement Tools

Seeing the value of practice guidelines in helping its members (and other providers as well) to wade their way through growing mountains of clinical evidence in order to find the best diagnostic and therapeutic approaches to the cardiovascular patient, the ACC and AHA have produced a succession of such documents. Over the years, the ACC and AHA have invited other specialty societies whose members are involved in the care of the cardiovascular patient to join in the development of the guidelines. Because of this inclusive approach and because of the explicit and standardized manner used to evaluate the evidence on which the guidelines are based,2 these documents are largely considered by providers, payers, and healthcare quality improvement entities of all kinds to represent the standard of care of the cardiovascular patient. This is true despite a recent analysis demonstrating that only 50% of the recommendations in the ACC/AHA guidelines are based on the highest level of evidence3—a fact that reflects not so much a weakness of the guidelines as the status of the evidence base in cardiovascular medicine.


  1. Frye RL, et al., J Am Coll Cardiol, 1984:434–42.
  2. American College of Cardiology, American Heart Association, Methodology Manual and Policies From the ACC/AHA Task Force on Practice Guidelines. Available at: AHA_Writing_Committees.pdf (accessed July 15, 2010).
  3. Tricoci P, et al., JAMA, 2009;301(8):831–41.
    Crossref | PubMed
  4. Spertus JA, et al., J Am Coll Cardiol, 2005;45:1147–56.
    Crossref | PubMed
  5. National Cardiovascular Data Registry. Available at: (accessed July 11, 2010).
  6. Radford MJ, et al., J Am Coll Cardiol, 2007;49:830–37.
    Crossref | PubMed
  7. Brindis RG, et al., J Am Coll Cardiol, 2005;46:1587–1605.
    Crossref | PubMed
  8. Eagle KA, et al., J Am Coll Cardiol, 2005;46:1242–8.
    Crossref | PubMed
  9. Bradley EH, et al., J Am Coll Cardiol, 2009;54;2423–9.
    Crossref | PubMed
  10. Hospital to Home (H2H). Available at: (accessed July 11, 2010).
  11. Drozda JP, et al., J Am Coll Cardiol, 2009;54;1744–6.
    Crossref | PubMed
  12. American College of Cardiology, PINNACLE Network. Available at: (accessed July 14, 2010).
  13. Hendel RC, et al., J Am Coll Cardiol, 2010;55(2):156–62.
    Crossref | PubMed
  14. Nyweide DJ, et al., JAMA, 2009;302(22):2444–50.
    Crossref | PubMed
  15. American College of Cardiology, CardioSource, Performance Improvement. Available at: Education/Performance-Improvement.aspx (accessed July 15, 2010).