This post was authored by Sarah Clarke, MD, FACC, vice president of Education and Research for the British Cardiovascular Society.

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Interesting joint session of the British Cardiovascular Society (BCS) and ACC, chaired by Drs. Iain Simpson of BCS and John Harold, vice president of the ACC, comparing and contrasting process of establishing guidelines in the UK vs. US.

The National Institute of Clinical Excellence (NICE) in the UK not only recommend on clinical evidence but also on cost effectiveness. In terms of implementation, the final decision rests with Commissioners. Whilst NICE was established to reduce postcode medicine, unfortunately uptake of guidance can vary by Commissioner. Commissioning in the UK is increasingly being devolved more locally. The UK has access to several guidelines- those from NICE, ESC and ACC. The BCS endorses the European Society of Cardiology (ESC) guidelines as these are based solely on clinical evidence.

It was felt that guidance in the US was less stringent than Europe and led to more variability in practice. Patient involvement in guidelines was discussed. In the UK patients are represented on guideline committees and it is felt invaluable to keep the panel focussed on the patient! In a cash strapped NHS patients are able to be rational in assessing additional benefits of new drugs especially where cost implications are concerned.

The NICE stable angina and ACS guidelines were reviewed in brief and compared to ESC and ACC guidelines as an illustration.

It was interesting to compare the approval process for clinical research studies in the UK vs. the US where it is particularly protracted. The process is being streamlined in the UK.

Overall it was a well-attended, informative session.

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

For more information about ACC’s International Activities visit the International Center on CardioSource.org.

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