Differences and similarities between American and European myocardial revascularization guidelines

Abstract

The development and update of clinical guidelines are based on an evaluation of the latest data from clinical studies. According to the National Academy of Medicine, clinical practice guidelines are ‘statements that include recommendations intended to optimize patient care that is informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options’. These expert documents are intended to provide systematically developed statements that include recommendations on how to translate clinical knowledge from scientific evidence into best patient-centred, evidence-based practice. Supplementing the textbook, clinical guidelines are now being increasingly considered decision drivers, and are being used by healthcare providers to choose the most appropriate diagnostic or therapeutic managing strategy, standardize care, reduce variation, and improve outcomes. The core of each of the clinical practice guidelines are the recommendations developed according to an established scale of the hierarchy of evidence. Although randomized controlled trials are at the top of the pyramid of evidence as the preferred study design for assessing the effects of two or more interventions, in many instances, task force members must rely on findings from observational studies. This is particularly so as trial patients may not always be typical of routine clinical practice. Hence, valuable information can be obtained from both randomized controlled trials and observational studies, including subgroup analysis, cohorts, or case series; therefore, each type of scientific research can be a significant complement to the other and contribute to guideline developments.