<International Circulation>: The trend today is towards individualized prevention therapy to tackle cardiovascular disease. What are the contributing factors towards these trends and do they reflect observations and findings from clinical trials and studies， and specifically trials such as COURAGE and BARI2D?

    Dr Spertus:  That is a very good and complicated question. Traditionally， cardiology has been very slow in adopting evidence from clinical trials into routine practice. It took us seventeen years， after there were definitive trials showing that aspirin within 24 hours of an MI saved lives， for more than half of patients to get an aspirin. That really is a remarkable delay in the translation of knowledge into practice. How easy is it to give someone with crushing chest pain an aspirin within a day of them presenting to a hospital? To address that gap， there has been the development of performance measures which are considered a subset of the Guidelines. Performance measures differ from guidelines and appropriate use criteria because instead of representing what you ‘can’ or ‘should’ do， they indicate what you ‘must’ do. For something to be considered a performance measure， it indicates that if you don’t apply this to a patient you are potentially doing harm. We have now started to alter the way we study and the way we deliver health care by explicitly collecting and measuring our adherence to performance measures and feeding them back to clinicians as a basis for public reporting and accountability. I believe that， as we need to translate new knowledge into practice， we need to continually challenge ourselves to figure out how we are going to speed the adoption – is it going to be large clinical trials addressing a real gap in knowledge， or is it going to be the development of ways of measuring and holding accountable physicians， and patients for that matter， to adherence to recommended guidelines. This is what the field is struggling with right now.