Today the Journal of the American Medical Association released an article about the importance of funding clinical research, including comparative effectiveness research, to determine the best ways to diagnose and treat heart disease. We at the ACC could not agree more. In fact, one of our staff members is an author of the article, by Drs.Tricoci, Sid Smith and Rob Califf, and our own ACC Joe Allen. The paper sends an important message to the new Administration, Congress and the nation about the need to invest more in science, medical evidence and clinical comparative effectiveness. To turbocharge the guidelines we need a vast amount of new research and evidence! $1.1 billion for comparative effectiveness research and $10 billion for NIH is a start.

Unfortunately, accompanying the article is a disturbing JAMA editorial. The editorial suggests that ACC/American Heart Association clinical practice guidelines lack critical evidence support, despite the fact that they are by far the best evidence at our disposal — and we want more evidence to build more guidelines! Plus these authors suggest guidelines are “cookbooks.” Rather, they offer learning system opportunities to document when and where care should depart from a guideline for a given patient, helping to accumulate data on when and how guidelines need to be updated. No patient perfectly conforms to a guideline, but where is there better science to use to manage care?

The ACC/AHA clinical practice guidelines offer guidance to help health care providers determine the best treatment options for their patients.  These guidelines are developed after careful analysis of the strongest clinical trial evidence available at the time.  In some cases, however, evidence is limited or not available, so some recommendations are based on the consensus agreement of a panel of leading experts in the field of heart disease care.  Once drafted, the guidelines go through substantial peer review and content review by clinicians and scientists at the highest levels of each organization.  The published guidelines represent a product of academic and clinical commentary from a large group of the best minds in the field.

These outstanding guidelines have helped cardiovascular specialists make significant progress in the battle against heart disease. We introduced the first guidelines 25 years ago, and coronary heart disease death rates have fallen by more than 30 percent in the past decade alone. President Doug Weaver was interviewed by WSJ and USA Today, and Board VP Ralph Brindis was interviewed on this by the New York Times.

ACC President Doug Weaver says, “The editorial implies that we should go back 30 years to when a thousand different physicians made a thousand different care plans based on their personal judgments, biases and even lack of knowledge of rigorous scientific findings.” Dr. Weaver is absolutely right. To ignore the ACC/AHA guidelines would introduce even more variation in care than already exists in our health care system.

We DO need more research! But we must continue to apply the best evidence we have diligently NOW until that wonderful day when we have irrefutable evidence for most of what we do.

Please share your thoughts on the article, the editorial and the need for evidence-based guidelines by leaving a comment. Also, check out the recent commentary on guidelines from Immediate-past President Jim Dove, M.D., M.A.C.C.

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