ACC/AHA Publish Process Review to Celebrate 30 Years of Clinical Practice Guidelines

Marking the 30th anniversary of the first jointly published guidelines for the diagnosis and treatment of cardiovascular disease, the ACC and American Heart Association have issued an extensive review of the process used for evaluating cardiovascular research and writing practice guidelines for clinicians. The review, "The Evolution and Future of ACC/AHA Clinical Practices Guidelines: A 30-Year Journey," was published Aug. 4 in the Journal of the American College of Cardiology, and delves into the history of the guideline development process and identifies pertinent changes that will help to keep up with the progressive developments in medical research and technology.

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Publishing their first cooperative guideline in 1984 on cardiac pacemakers, the ACC and AHA have released a total of 23 clinical practice recommendations, addressing topics from congenital heart disease, acute coronary syndromes and vascular medicine. No longer enduring prolonged periods between updates and revisions, today's modern guidelines – published on various digital platforms – can host more modular adjustments and edits to match the latest evidence.

Other recent changes in the guideline development process include the addition of a separate process for conducting systematic reviews of research, the use of critical questions to focus the evidence review process, the addition of a lay representative on writing committees, the expansion of the peer review process, and an accelerated public release of the manuscripts.

Moving forward guidelines will even begin to address the cost effectiveness of treatments, implement a more integrated approach to treatment comorbidities, and update the process for managing and monitoring bias among guideline writing committee members that go beyond relationships with the medical industry.

The vision is for guideline recommendations to be embedded within electronic medical record systems and mobile devices that will be accessible at the point-of-care, and moving forward, the authors foresee increased harmonization of guidelines with other organizations in the U.S. and abroad to minimize confusion and enhance adherence to recommendations.

"Clinical Practice Guidelines are at the core of the work of the ACC and the AHA," said Jeffrey L. Anderson, MD, FACC, chair of the ACC/AHA Task Force on Practice Guidelines. "With this document, we are establishing a vision to maintain a commitment to evidence-based care while recognizing the realities of rapid advances in research and technology and constantly increasing demands on physicians' time."

Alice Jacobs, MD, FACC, former chair of the ACC/AHA Task Force on Practice Guidelines, adds that "The Task Force on Practice Guidelines carefully reviewed the guideline process and methods to ensure that future guidelines are current, relevant and useful at the point of care to busy clinicians." Further, "ACC/AHA guidelines have provided clinicians with evidence-based decision support for many decades. This document will provide a roadmap to ensure the guideline writing process embraces the rapid evolution of medical research and the equally rapid changes in technology for accessing guidelines."

Keywords: Electronic Health Records, Acute Coronary Syndrome, Cost-Benefit Analysis, Comorbidity, Peer Review, Publishing, Pacemaker, Artificial, Biomedical Research

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