Performance measures to promote quality improvement in sudden cardiac arrest prevention and treatment Sana M. Al-Khatib, MD, MHS, a Gregg C. Fonarow, MD, b David L. Hayes, MD, c Anne B. Curtis, MD, d Samuel F. Sears, Jr., PhD, e Gillian D. Sanders, PhD, a Adrian F. Hernandez, MD, MHS, a Michael J. Mirro, MD, f Kevin L. Thomas, MD, a Zubin J. Eapen, MD, a Andrea M. Russo, MD, g and Clyde W. Yancy, MD h Durham, and Greenville, NC; Los Angeles, CA; Rochester, MN; Buffalo, NY; Fort Wayne, IN; Camden, NJ; and Chicago, IL Sudden cardiac arrest (SCA) is one of the most impactful public health problems in the United States. Despite the progress made in reducing the number of cardiac deaths, the incidence of sudden cardiac death remains high. Studies of life-saving interventions for prevention and treatment of SCA, like β-blockers, aldosterone antagonists, implantable cardioverter defibrillator therapy, automated external defibrillators, and cardiopulmonary resuscitation, have brought to light substantial underutilization, variations in care, and disparities. Thus, a comprehensive systems-based approach to addressing these gaps in care should be implemented. In addition to educating stakeholders about SCA and its prevention and developing tools that could help physicians identify patients who could benefit from primary prevention of SCA, robust performance measures with strong, evidence-based association between process performance and patient outcomes are needed. In this article, we review the burden of SCA and highlight the need to develop performance measures related to the prevention and treatment of SCA. (Am Heart J 2013;165:862-8.) Sudden cardiac arrest (SCA) is a major public health problem in the United States that accounts for up to 350,000 deaths per year. 1-3 Although the overall number of sudden deaths appears to have decreased, its incidence remains substantial. 4 Survival after out-of-hospital SCA remains very poor. 5-7 The high incidence of SCA and its potential complications and associated costs make it a prime target for systems of care, quality improvement efforts, and the development of performance measures. The development of such measures is further supported by a clear proof of care gaps in SCA prevention and treatment. Gaps that should be the focus of future per- formance measures have been well demonstrated in a number of treatment and prevention domains including bystander cardiopulmonary resuscitation, use of automat- ed external defibrillators, use of medications that have been shown to reduce the risk of SCA, and use of im- plantable cardioverter defibrillator (ICD) therapy. Although it has been well established that patients who receive bystander cardiopulmonary resuscitation and prompt defibrillation by an external automated defibril- lator have a higher chance of surviving an out-of-hospital cardiac arrest than those who do not, several studies have demonstrated substantial underuse of bystander cardio- pulmonary resuscitation and automated external defibril- lators and major racial disparities with whites being significantly more likely to receive these interventions than blacks, Hispanics, or members of other racial populations. 7-9 There are also gaps, variations, and disparities in the use of medications that reduce the risk of SCA in heart failure and post-myocardial infarction (MI) with left ventricular (LV) dysfunction patients, including β-blockers and aldosterone antagonists. 10,11 Likewise, several studies have shown considerable underutilization of primary prevention ICD therapy in patients with heart failure with reduced LV ejection fraction (LVEF) as well as major sex and racial disparities in its use, despite the mounting evidence that ICD therapy saves lives. 12-20 In this article, we provide an overview of performance measures and highlight the need for publicly-reported SCA performance measures related to the primary and secondary prevention of SCA and its treatment. From the a Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, b Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, c Mayo Clinic, Rochester, MN, d University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, e Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, f Parkview Health System, Fort Wayne, IN, g UMDNJ/Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ, and h Northwestern University, Feinberg School of Medicine, Chicago, IL. Bernard J. Gersh, MB, ChB, DPhil served as guest editor for this article. Submitted November 20, 2012; accepted February 14, 2013. Reprint requests: Sana M. Al-Khatib, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail: alkha001@mc.duke.edu 0002-8703/$ - see front matter © 2013, Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.ahj.2013.02.010 Curriculum in Cardiology