News | August 15, 2014

Societies Mark 30 Years of Guidelines for Evidence-Based Cardiovascular Care

ACC/AHA review, update process for producing clinical practice guidelines

August 15, 2014 — Marking the 30th anniversary of the publication of their first joint guidelines for the diagnosis and treatment of heart disease, the American College of Cardiology (ACC) and the American Heart Association (AHA) published an extensive review of the process and methodology for evaluating cardiovascular research and writing practice guidelines for clinicians.

The Evolution and Future of ACC/AHA Clinical Practice Guidelines: A 30-Year Journey describes the history of the guideline development processes and identifies changes to keep up with rapid developments in medical research as well as technological advances that impact how busy clinicians access information. 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.

“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,” said Alice Jacobs, M.D., immediate past chair of the ACC/AHA Task Force on Practice Guidelines and chair of the ACC/AHA Methodology Summit held to discuss these changes and others proposed by the Institute of Medicine. “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.”

The first ACC/AHA guideline, evaluating evidence about cardiac pacemakers, was published in 1984. Over the years, the organizations have developed and updated clinical practice guidelines on 23 different topics from acute coronary syndromes to congenital heart disease and vascular medicine. Through the work of volunteer writing committees, the ACC and AHA also create supporting materials such as pocket guides and quality management products derived from guidelines, including performance measures and appropriate use criteria (AUC).

Looking ahead, future guidelines will be more nimble “living” documents published on various digital platforms that allow for more frequent modular updates as evidence evolves. The vision is for guideline recommendations to be embedded within electronic medical record (EMR) systems and mobile devices that will be accessible at the point of care. The document also recommends that future guidelines address the cost effectiveness of treatments and provide a more integrated approach to treatment for co-morbidities; and it foresees increased harmonization of guidelines with other organizations in the United States 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, M.D., current 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.”

The new document outlines an updated process for managing and monitoring potential bias among guideline writing committee members that goes beyond relationships with industry. Potential biases that may be relevant to the writing effort can include academic setting, race, gender, geography, intellectual stance or scope of clinical practice. The guideline process relies on the principles of “define, disclose and manage” for addressing potential bias, recognizing that sometimes participants with relationships with industry can be the most knowledgeable on given issues. Relationships with industry are reported upon appointment to the writing committees, at the start of all meetings of the committees, and in the final written report. All the writing committee chairs and a majority of each committee’s members must be free of relevant relationships with industry in the previous year and throughout the guideline development process.

For more information: www.cardiosource.org/ACC

Related Content

CareSelect Declared Fully Qualified Clinical Decision Support Mechanism by CMS
News | Clinical Decision Support| July 18, 2017
National Decision Support Company announced the full qualification of its CareSelect Platform as a Qualified Clinical...
CMS Proposes Delaying Clinical Decision Support Documentation to 2019
News | Clinical Decision Support| July 14, 2017 | Jeff Zagoudis, Associate Editor
In a series of proposed rule changes to the Medicare Physician Fee Schedule (MPFS) released July 13, the Centers for...
Sponsored Content | Videos | Clinical Decision Support| June 29, 2017
Rami Doukky, M.D., system chair, Division of Cardiology, professor of medicine, Cook County Health and Hospitals Syst
Partners HealthCare and GE Healthcare Launch 10-year Collaboration on Artificial Intelligence
News | Artificial Intelligence| May 17, 2017
May 17, 2017 — Partners HealthCare and GE Healthcare announced a 10-year collaboration to rapidly develop, validate a
Siemens Healthineers Supports Population Health Management With Planned Acquisition of Medicalis
News | Clinical Decision Support| April 19, 2017
Siemens Healthineers plans to expand its Population Health Management (PHM) portfolio with the acquisition of Medicalis...

Physicians will need to use a CMS-certified appropriate use criteria (AUC) clinical decision support software that documents the appropriateness of an imaging order to receive full reimbursement for Medicare patients starting Jan. 1, 2018.

Feature | Cardiac Imaging| April 18, 2017 | Dave Fornell
As part of U.S. healthcare reform efforts, starting Jan.
ACR Appropriateness Criteria, update, new topics, medical imaging, AUC, American College of Radiology
News | Clinical Decision Support| April 03, 2017
The newest release of American College of Radiology (ACR) Appropriateness Criteria covers 230 topics with more than 1,...
ECRI Institute, top 10 patient safety concerns, 2017 report, information technology, healthcare
News | Information Technology| March 24, 2017
Safe implementation of new technologies and therapies accompany classic patient safety challenges on ECRI Institute's “...
iFR, iFR vs. FFR, ACC late breaking trial, iFR-SWEDEHEART, DEFINE-FLAIR, Justin E. Davies,

Matthias Götberg, principal investigator for the iFR-SWEDEHEART study, and Justin E. Davies, lead investigator for the DEFINE-FLAIR trial, share key points of their study with DAIC editor Dave Fornell at ACC.17. The trials showed iFR is equal in outcomes to FFR in assessing coronary lesions. 

Feature | FFR Catheters| March 20, 2017
March 20, 2017 — For patients experiencing angina (chest pain) or a heart attack, instantaneous wave-free ratio (iFR)
AI, deep learning, artificial intelligence, medical imaging, cardiology, echo AI, clinical decision support, echocardiography

An example of artificial intelligence from the start-up company Viz. The image shows how the AI software automatically reviews an echocardiogram, completes an automated left ventricular ejection fraction quantification and then presents the data side by side with the original cardiology report. The goal of the software is to augment clinicians and cardiologists by helping them speed workflow, act as a second set of eyes and aid clinical decision support.

Feature | Artificial Intelligence| March 10, 2017 | Dave Fornell
Artificial intelligence (AI) has captured the imagination and attention of doctors over the past couple years as seve
Overlay Init