The CDPH requested pilot hospital applications in December 2009, selected 6 hospitals out of over 30 applicant hospitals in May 2010 and contracted with University of California, Davis (UCD) to train, audit, and monitor the program. The CDPH appointed a 12 member Advisory Oversight Committee (AOC) with 6 at-large members nominated by the California American College of Cardiology (CAACC) and 6 members from the pilot hospitals (1 principal investigator from each participating pilot hospital). The pilot program was funded by CDPH from fee assessments of participating pilot hospitals. The study was approved by the Institutional Review Board (IRB) at each pilot hospital and at the University of UCD coordinating center, and each patient is asked to provide written informed consent for pilot participation (unless unavailable in critically ill patients).