The focus of this symposium is Maryland's heart attack problem. The question is: Can the known evidence-based data on heart attacks be interpreted and applied in a systematic way that will unite efforts to reduce the significant heart attack deaths within the state? To determine this we need to go beyond what is currently being done and aim at a higher level of performance. Despite the medical advances in clot-dissolving therapies and minimally invasive surgeries, the acute prevention of heart attack death and damage has not been substantial. However, significant progress is possible. Better delivery systems, linking hospitals and communities, are needed. To accomplish this, emergency physicians and nurses, cardiologists, and paramedics need to form part of a team and have the support of the individual hospitals and the emergency medical system. Chest pain centers must function efficiently and cost effectively and bring about a community involvement that can significantly reduce heart attack deaths locally and, when combined with other hospitals, statewide.