It is possible to assemble information on a diverse set of clinical performance measures that represent performance on the range of services in a health insurance program. These findings indicate substantial opportunities to improve the care delivered to Medicare beneficiaries and urgently invite a partnership among practitioners, hospitals, health plans, and purchasers to achieve that improvement. JAMA. 2000;284:1670-1676.

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EART FAILURE IS A NATIONAL epidemic, affecting nearly 5 million persons in the United States, with an additional 550 000 diagnosed each year. 1 This burden is disproportionately borne by black Americans, who have a higher incidence and prevalence of heart failure than members of other racial groups. 1 Despite this greater burden, black patients may receive less intensive and poorer-quality care for heart failure than whites. 2-5 Some studies, however, suggest that black patients receive similar quality of care as members of other racial groups. 6-10 Because prior studies evaluated patients treated in selected centers or regions 6-10 and assessed treatment or utilization patterns and not objective measures of quality of care, 3,9,10 it is unclear if reported racial differences reflect shortfalls in care or appropriate treatment or are representative of current national practice patterns. A national evaluation of racial patterns of heart failure care is timely given the

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In elderly patients hospitalized with HF, preserved systolic function is primarily a condition of women, independent of important demographic and clinical characteristics.