Global lessons for quality care: a tale of two countries

With growing awareness of persistent care gaps and emerging evidence that improved care processes can influence patient outcomes,1–3 attention has been directed to evaluate quality of care to optimise the application of evidence-based therapies. Although international patterns of cardiovascular care have been the focus of previous research,4–9 comparisons have been hampered by disparities in data collection.10 Recently, both the American College of Cardiology and American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have proposed respective sets of quality indicators (QI) for acute coronary syndrome (ACS).11 12Utilisation of these standardised measures appears to be the next logical step to investigate how different systems perform in ACS management, and to identify opportunities to improve the quality of cardiovascular care across the globe.In this observational study involving two large national ACS databases from Israel (Acute Coronary Syndrome in Israel Survey, ACSIS) and UK (Myocardial Ischaemia National Audit Project, MINAP), Zusman et al compare the temporal changes in ACS care at three timepoints (2006, 2010 and 2013) using the ESC ACS QI, including composite QI scores calculated both by opportunity and all-or-none methodologies.13 Over time, both countries saw an increase in invasive coronary management, with a greater increase …