Perspective:

The following are 10 points to remember about strategies to enhance application of clinical practice guidelines (CPGs) in patients with cardiovascular disease and comorbid conditions:

1. Cardiovascular disease, the leading cause of death in the United States and worldwide, accounts for substantial suffering and healthcare-related expenditures.

2. For more than 30 years, the American Heart Association (AHA) and the American College of Cardiology (ACC) have partnered with other organizations to translate the best available scientific evidence into CPGs for cardiovascular conditions.

3. CPGs are essential tools for optimizing care for patients with cardiovascular conditions. Enhancing the utility of CPGs requires that the development process reflect the evolution of relevant foundational domains, such as biomedical discoveries, public policy, clinical care systems, and epidemiological knowledge.

4. With the exception of the CPGs on atrial fibrillation and heart failure, CPGs have not systematically incorporated recommendations on how common comorbidities that accompany a specific cardiovascular condition might affect the care and management of patients with comorbidities.

5. With progressive growth in the size of the older adult population and the increased prevalence of comorbidities in patients with cardiovascular conditions, organizations that develop CPGs must now consider comorbidities during the development process for disease-specific CPGs.

6. Involving patients in the CPG development process, which the AHA/ACC recently initiated, is critically important to fully appreciate patient perspectives.

7. Given the current lack of trial evidence and the complexity of treating patients with common cardiovascular comorbidities, CPGs may, in certain instances, need to be more nuanced to account for clinical judgment and acknowledge the role of individualized, patient-centered decision making in implementation.

8. In the future, the AHA/ACC CPGs will explicitly discuss the applicability and quality of recommendations for the most frequent combinations of comorbidities that accompany cardiovascular conditions.

9. An important step in this direction is the collaboration between the AHA/ACC and the Department of Health and Human Services that includes development of comorbidity data for selected cardiovascular conditions that, in turn, can be included and addressed in CPGs, such as the most recent guidelines on atrial fibrillation and heart failure.

10. The AHA/ACC aim to partner with various organizations to determine how best to highlight and address the complex issues arising from comorbidities in clinical medicine.