The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.

Abstract

In 2014, we mark the 30th anniversary of the first publication of an American College of Cardiology (ACC) and American Heart Association (AHA) clinical practice guideline (CPG). This joint effort was undertaken in response to the US government’s request to review the evidence concerning cardiac pacemakers and develop CPGs to mitigate potential overuse. Since then, fueled by a shared sense of responsibility to translate available evidence into clinical practice to guide cardiovascular clinicians, the ACC and AHA have developed 23 CPGs across the spectrum of cardiovascular diseases and procedures. The “why” and “how” of CPGs continue to evolve. Although the “why” is based on the directive to develop evidence-based recommendations for selection of diagnostic tests, procedures, and treatments to improve quality of care and outcomes for patients with cardiovascular disease, it is precisely where evidence is lacking or is controversial that clinicians need the most guidance. A 2012 survey of ACC and AHA members provides important insight into the way clinicians and other healthcare professionals apply CPGs; further details are provided below. The results highlight a natural tension between the needs of clinicians for comprehensive clinical advice from seasoned experts and for a clear delineation of diagnostic and therapeutic measures for which strong scientific evidence exists. Notably, there has been an increased focus on the “how” of CPGs and changes in the methodology used to collect and evaluate the evidence. In 2011, the Institute of Medicine (IOM) published 2 reports, Clinical Practice Guidelines We Can Trust 1 and Finding What Works in Health Care: Standards for Systematic Reviews .2 In response to these reports and our own mandate to continually improve processes and methods while evaluating the continuous stream of new knowledge and maintaining relevance at the point of care, the ACC/AHA Task Force on Practice Guidelines (Task Force) …