Tools for Guiding Clinical Practice From the American Heart Association and the American College of Cardiology

Abstract

Every day, clinicians face difficult decisions on how best to manage a given patient. Important decisions include selection of the appropriate diagnostic tests, procedures, and/or treatments to improve a patient’s outcomes. Ideally, these decisions should be informed and guided by the best medical evidence. In reality, however, clinical practice tends to be highly variable.1 Concerned that a lack of standards for pacemaker implantation was leading to potential overutilization, governmental regulators asked the American Heart Association (AHA) and American College of Cardiology (ACC) in 1984 to evaluate the available evidence and develop recommendations for practice. This led to what became their first clinical practice guideline (CPG).2 Since then, the work of the ACC/AHA Task Force on Practice Guidelines has expanded markedly, currently monitoring ≈17 CPG areas (with a major focus on disease management) and determining when revisions or updates are needed to accurately reflect the evolution of evidence in cardiovascular care. Article p 1330 The process for developing CPGs was outlined in 2003.3,4 The core focus of CPG writing committees is to review and summarize the evidence in the medical literature, relying heavily on randomized controlled trials (RCTs) and when these are not available to turn to other data sources including other forms of trials, meta-analyses, and registry data. The recommendations put forth in a CPG are rigorously classified according to whether a test, procedure, or other treatment is “useful and effective” in a given setting, as well according to the level of evidence supporting this view.3 A notable example of the effort of the Task Force on Practice Guidelines to provide timely responses to a rapidly changing evidence base has been the development of focused updates, the first 3 of which dealt with ST-elevation myocardial infarction, percutaneous coronary intervention, and chronic stable angina, responding to the …