title: The effectiveness of national guidelines for preventing cardiovascular disease: integrating effectiveness concepts and evaluating guidelines' use in the real world.
abstract: OBJECTIVE
  Clinical guidelines historically have emphasized efficacy (intervention benefit in a controlled or experimental setting) rather than effectiveness (intervention benefit in the real world). This review examines how concepts of effectiveness currently influence the development of guidelines for prevention of cardiovascular disease, and how these concepts contribute to increased evaluation of guideline effectiveness.
  
  
  RESULTS
  A growing emphasis on effectiveness in cardiovascular preventive guidelines is largely influenced by a desire for guidelines to facilitate improved quality of care. Single risk factor guidelines for cardiovascular disease are being merged, and guideline recommendations are becoming simpler and easier to implement into practice. Simultaneously, guideline programs are undertaking a wider range of development, implementation and evaluation activities. Implementation science, a supporting discipline, is rapidly maturing and resulting in increasingly sophisticated studies designed to test the effectiveness of prevention interventions and approaches to improve guideline uptake. Modelling studies are used to develop effective guideline recommendations and evaluate the overall effectiveness of guidelines for reducing cardiovascular disease.
  
  
  CONCLUSIONS
  A sea change is occurring in cardiovascular guidelines toward effectiveness and prevention of multiple chronic diseases, and away from a focus on the efficacy of medical therapy for individual cardiovascular disease risk factors. The 'effectiveness sea' should eventually stretch to embrace cost-effectiveness and population effectiveness.
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dmanuel@ohri.ca
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic / Q000592:standards; D006287:Health Planning Guidelines; D006801:Humans; D011786:Quality Control; D012307:Risk Factors