AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and US Department of Health and Human Services.

Abstract

Cardiovascular disease, the leading cause of death in the United States and worldwide, accounts for substantial suffering and healthcare-related expenditures.1–3 For more than 30 years, the American Heart Association (AHA) and the American College of Cardiology (ACC) have partnered with other organizations to translate the best available scientific evidence into clinical practice guidelines (CPGs) for cardiovascular conditions. These efforts reflect a shared vision and responsibility for using scientific evidence and the expert clinical opinion of leaders in the field to develop recommendations for healthcare providers. These CPGs, based on systematic methods to evaluate and classify evidence, have provided the cornerstones for delivering quality cardiovascular care. CPGs are essential tools for optimizing care for patients with cardiovascular conditions. Enhancing the utility of CPGs requires that the development process reflect the evolution of relevant foundational domains, such as biomedical discoveries, public policy, clinical care systems, and epidemiological knowledge. Dynamic changes in these domains pose substantial implications for organizations that develop CPGs. Among these changes is the increasing prevalence of ≥2 chronic conditions among individual Americans, estimated to be present in more than one quarter of adults.4 In the large population of Medicare beneficiaries, the prevalence of persons with multiple chronic conditions is considerably greater: more than two thirds (68%) have ≥2 chronic conditions, and 14% have ≥6 chronic conditions.5,6 CPGs jointly developed by the AHA/ACC are cardiovascular disease-specific documents focused on the prevention, diagnosis, and management of conditions such as ischemic heart disease, heart failure, and atrial fibrillation. These CPGs often contain considerations for special factors (eg, older adults) and common problems affecting pharmacokinetics (eg, renal impairment). For example, the 2014 CPG on atrial fibrillation7 highlights special considerations for acute myocardial infarction, pregnancy, hyperthyroidism, and other conditions. With the exception of the CPGs on …