ACCF/AHA Update Clinical Practice Guideline Methodology

On Dec. 10 the ACC Foundation (ACCF) and American Heart Association released a summary of changes to current ACCF/AHA Guideline methodology, in order to continue to develop timely clinical practice guidelines that also meet new Institute of Medicine (IOM) standards.

The recommendations were derived from a two-day intensive Methodology Summit in December 2011 where the ACCF/AHA Task Force on Practice Guidelines compared and contrasted current methods against standards set forth by the IOM as the ideal methods for developing trustworthy practice guidelines.

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Specifically, the additions to the existing ACCF/AHA guidelines methodology are:

  • Inclusion of Patient Representatives - The Task Force will invite patient representatives (defined as patients and former patients, patient advocate, or patient/consumer organization. representative) to participate as a member of the Task Force and a guideline writing committee.
  • Systematic Review Using Standardized Protocols - The ACCF/AHA methodology will incorporate a formal systematic review of the evidence, initially, with a focused approach to a confined topic.
  • Evidence Review Committee - The current guideline development process will expand to include a separate evidence review committee, tasked with the systematic review process, in addition to a guideline writing committee, tasked with creating the scientific document.
  • Intellectual and Practice Perspectives - In addition to the strict relationship with Industry policy operative within the guideline development, review and approval process, the concept of intellectual and practice perspective (the latter term is operative when an individual‘s income is enhanced by performing a specific test or procedure relevant to the guideline topic) will be defined, recognized, and managed.
  • Expanded Review Process - An expanded group of external reviewers will be added to the extensive peer review process for the completed guideline before publication.  External reviewers will comprise a full spectrum of relevant stakeholders, including public representatives and constituencies such as governmental agencies.

"This was a natural next step in the evolution of our process and methods as we strive to integrate and respond to the continuous stream of new knowledge," said Alice Jacobs, MD, FACC, immediate past chair of the ACCF/AHA Task Force on Practice Guidelines. "At the time the IOM report was released, we were already compliant with many of the proposed standards, but we used this as an opportunity to continue to improve." 

The ACCF and AHA have jointly developed and published 17 clinical practice guidelines since the early 1980s through a highly robust process.  These guidelines are broadly disease based, and are based on a shared commitment of translating the best available scientific evidence into clinical practice guidelines and performance measures that can be used by healthcare professionals to improve patient outcomes and quality cardiovascular care.

Moving forward, the guidelines process and methodology will continue to evolve through ongoing process and methodology improvement initiatives that address how to best incorporate the continual stream of new knowledge while maintaining a robust process for development, peer review and organization approval, added Jacobs.

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