Investigating the quality of care in cardiovascular medicine.

Clinical researchers investigate the association between disease management, such as drugs, devices, diagnostic tools, severity classification, and symptom gradients, and patient outcomes, including some surrogate measures. Well-conducted research has provided data relevant to clinical practice, and many more patients who were not investigated under the researches also receive the benefit of such proven disease management. However, who would not enjoy the state-of-theart practice? Of course, there are other factors that become obstacles to the dissemination of state-of-the-art practice, such as lack of funds or a lower educational level of patients and the general public. Japan is a unique country among the developed countries in that, within its healthcare system, all patients can receive ideal standard practice under universal healthcare insurance with limited payment. If there is any variation in disease management between patients, however, the reasons uality of care should be a core value within modern healthcare systems. Cardiovascular medicine is the one of the most advanced medical subspecialties in providing evidence-based, state-of-the-art practices in developed countries. In spite of this, in the USA, medical interventions, not diseases themselves, resulted in approximately 44,000–98,000 fatalities per year and roughly 1 in 100 patients admitted to hospitals died because of a medical intervention.1 The risk of undergoing medical care is considered the worst compared to many industries and other human activities (Figure 1).2 We are aware that medicine has saved many more lives in history; therefore, we have conducted much research in both basic and clinical sciences to maximize saved lives and minimize injuries from medical interventions. Much clinical research has attempted to explore the association between disease management and patient outcomes, whereas basic science research has investigated the principles of such association, even before the association has been identified. Q