Heart Association to develop the first clinical practice guidelines for cardiovascular practice. In the 1990s, the college used the guidelines to lay the groundwork for studies documenting discrepancies best and actual cardiovascular practices. The college works with national organizations such as the National Heart, Lung and Blood Institute to continually develop and update these guidelines. Performance measures and Data standards In 2000, the college partnered with the American Heart Association to begin development and publication of national performance measurement standards and data standards for both inpatient and outpatient care based on the guidelines. Measurement sets include: coronary artery disease, hypertension, heart failure, atrial fibrillation, cardiac rehabilitation, myocardial infarction, primary prevention and peripheral arterial disease. In addition, the college has submitted its measures to the National Quality Forum, with the majority of its measures receiving endorsement as national standards. The college has also collaborated with specialty societies to undertake the task of developing and publishing clinical data standards. Clinical data standards developed include those for acute coronary syndrome, atrial fibrillation, heart failure and electrophysiology. Appropriate-use criteria The college has published criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), computed tomography of the heart and cardiac magnetic resonance imaging, resting transthoracic and transesophageal echocardiography, and coronary revascularization. Data registries The college's National Cardiovascular Data Registry is a source for measuring and quantifying outcomes and identifying gaps in the delivery of quality care. Its data are used in select pay-for-reporting and/or performance programs to demonstrate the benefits and challenges of such incentive programs. To date, the college has developed five hospital-based cardiovascular registries. In addition, the PINNACLE Registry is the nation's first and largest practice-based cardiovascular registry. In 2011, the college and The Society of Thoracic Surgeons launched the STS/ACC TVT Registry, which tracks transcatheter valve therapy procedures. National quality initiatives Currently several key quality initiatives are underway to help translate science into practice and improve outcomes for cardiovascular patients. These projects include the Door to Balloon Alliance, Hospital to Home and Imaging in FOCUS. Launched in November 2006, the Door to Balloon Alliance is focused on helping hospital not only reduce, but successfully sustain the guideline-recommended time of 90 minutes or less from the time a patient with chest pain arrives at an emergency room until they have a balloon dilatation procedure. The alliance provides hospitals with the evidence-based strategies and resources to focus on process improvement, interdisciplinary cooperation