This post was authored by Jeffrey L. Anderson, MD, FACC, chair, Jonathan L. Halperin, MD, FACC, chair-elect and Alice K. Jacobs, MD, FACC, immediate past chair of the ACCF/AHA Task Force on Practice Guidelines.

A recent column in the December issue of CardioSource WorldNews questions whether clinical guidelines meet new standards set by the Institute of Medicine (IOM) for developing trustworthy practice guidelines.  The issue went to press shortly before the release of an American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) Guideline Methodology Summit report in the Journal of the American College of Cardiology and Circulation that summarizes changes to the ACCF/AHA guideline development process.

The changes are designed to facilitate development of timely clinical practice guidelines that meet the new standards. Before the IOM report was released, the ACCF/AHA guidelines were already compliant with most of the IOM recommendations, as the Task Force on Practice Guidelines strives to develop guidelines that incorporate new knowledge while maintaining rigorous evidence review.  

At the Methodology Summit held in December 2011, the Task Force critically assessed its methods and incorporated several changes based on the IOM report, including the following:

• Inclusion of Patient Representatives - The Task Force will invite patient representatives (defined as patients and former patients, patient advocates, or patient/consumer organization representatives) to participate as members of the Task Force and guideline writing committees.
• Systematic Review Using Standardized Protocols - The ACCF/AHA methodology will incorporate formal systematic review of the evidence and a focused approach to confined topics.
• Evidence Review Committee - The current guideline development process has been expanded to include separate evidence review committees tasked with critically reviewing the evidence, in addition to guideline writing committees, tasked with creating clinical recommendations.
• Intellectual and Practice Perspectives - In addition to the strict policies pertaining to relationships with industry and other entities already incorporated in the review and approval process, the concepts of intellectual and practice perspectives (the latter term operative when an individual performs a test or procedure pertinent to the guideline topic) will be defined, managed and disclosed with transparency.
• Expanded Review Process - An expanded group of external reviewers will be added to the peer review process for completed guidelines before publication.  External reviewers will include a full spectrum of relevant stakeholders, including public representatives and constituencies, such as government agencies.
  

Since the 1980s, the ACCF and AHA have jointly developed and published clinical practice guidelines on 17 topics through a robust process. The guidelines are broadly disease-based, and are centered on a shared commitment to translating the best available scientific evidence into clinical practice recommendations that can be used by healthcare professionals to enhance cardiovascular care and improve patient outcomes. The methodology will continue to evolve through ongoing improvement initiatives.