THEROTHROMBOSIS (COROnary artery disease [CAD], cerebrovascular disease [CVD], and peripheral arterial disease [PAD]) is associated with the main causes of mortality on a worldwide scale. Recent US data have confirmed that despite a decrease in agestandardized national death rates, the absolute number of deaths from these conditions continues to increase, 1 and prevalence is sharply increasing in other parts of the world. Thus, atherothrombotic diseases are, and are projected still to be, the leading cause of death worldwide by 2020. 2 Thus far, most of the information available on atherothrombosis risk has been derived from single regional locales (such as studies conducted in Europe or North America), often confined to a single subtype of patient (patients with CAD, previous stroke patients without PAD), and generally limited to hospitalized patients (as op-posed to outpatients or individuals in primary care) or to patients in clinical trials (as opposed to patients in the community).The REACH (Reduction of Atherothrombosis for Continued Health) Registry has been established to circumvent these limitations by recruit-For editorial comment see p 1253.

A significant association between care process and outcomes was found, supporting the use of broad, guideline-based performance metrics as a means of assessing and helping improve hospital quality.

the REACH Registry Investigators. JAMA 2010;304:1350-7.Conclusion: Patients with vascular events are those at highest risk for future cardiovascular death, myocardial infarction, and stroke.Summary: Clinical trials of pharmacologic agents in patients with atherosclerosis often report event rates in placebo groups lower than projected (Bhatt DL, N Engl

Background-Hospitals use patient satisfaction surveys to assess their quality of care. A key question is whether these data provide valid information about the medically related quality of hospital care. The objective of this study was to determine whether patient satisfaction is associated with adherence to practice guidelines and outcomes for acute myocardial infarction and to identify the key drivers of patient satisfaction. Methods and Results-We examined clinical data on 6467 patients with acute myocardial infarction treated at 25 US hospitals participating in the CRUSADE initiative from 2001 to 2006. Press Ganey patient satisfaction surveys for cardiac admissions were also available from 3562 patients treated at these same 25 centers over this period. Patient satisfaction was positively correlated with 13 of 14 acute myocardial infarction performance measures. After controlling for a hospital's overall guideline adherence score, higher patient satisfaction scores were associated with lower risk-adjusted inpatient mortality (Pϭ0.025). One-quartile changes in both patient satisfaction and guideline adherence scores produced similar changes in predicted survival. For example, a 1-quartile change (75th to 100th) in either the patient satisfaction score or the guideline adherence score yielded the same change in predicted survival (odds ratio, 1.24; 95% CI, 1.02 to 1.49; and odds ratio, 1.24; 95% CI, 1.08 to 1.41, respectively). Satisfaction with nursing care was the most important determinant of overall patient satisfaction (PϽ0.001). Conclusions-Higher patient satisfaction is associated with improved guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive. Thus, patients' satisfaction with their care provides important incremental information on the quality of acute myocardial infarction care. (Circ Cardiovasc Qual Outcomes. 2010;3:188-195.)