Improving clinical practice guidelines for practicing cardiologists.
Cardiac-related clinical practice guidelines have become an integral part of the practice of cardiology. Unfortunately, these guidelines are often long, complex, and difficult for practicing cardiologists to use. Guidelines should be condensed and their format upgraded, so that the key messages are easier to comprehend and can be applied more readily by those involved in patient care. After presenting the historical background and describing the guideline structure, we make several recommendations to make clinical practice guidelines more user-friendly for clinical cardiologists. Our most important recommendations are that the clinical cardiology guidelines should focus exclusively on (1) class I recommendations with established benefits that are supported by randomized clinical trials and (2) class III recommendations for diagnostic or therapeutic approaches in which quality studies show no benefit or possible harm. Class II recommendations are not evidence based but reflect expert opinions related to published clinical studies, with potential for personal bias by members of the guideline committee. Class II recommendations should be published separately as "Expert Consensus Statements" or "Task Force Committee Opinions," so that both majority and minority expert opinions can be presented in a less dogmatic form than the way these recommendations currently appear in clinical practice guidelines.
Tel Aviv Medical Center, Tel Aviv, Israel.
Jesaia
J
Benhorin
Long Island Jewish Medical Center.
Monty
M
Bodenheimer
University of Rochester Medical Center.
Mary
M
Brown
Emeritus, St. Luke's-Roosevelt Hospital Center.
Robert
R
Case
New Jersey School of Medicine.
Edward M
EM
Dwyer
University of Rochester Medical Center.
Shirley
S
Eberly
University of Rochester Medical Center.
Charles
C
Francis
Upstate New York School of Medicine, Buffalo, New York.
John A
JA
Gillespie
Uniformed Services University of the Health Sciences.
Robert E
RE
Goldstein
Mailman School of Public Health, Columbia University, New York City, New York.
Henry
H
Greenberg
Uniformed Services University of the Health Sciences.
Mark
M
Haigney
Washington University in St. Louis School of Medicine.
Ronald J
RJ
Krone
Emeritus, Otto von Guericke University, Germany.
Helmut
H
Klein
Maimonides Medical Center, Brooklyn, New York.
Edgar
E
Lichstein
Niguarda Hospital, Milan, Italy.
Emanuela
E
Locati
University of Arizona Health Sciences Center.
Frank I
FI
Marcus
University of Rochester Medical Center. Electronic address: heartajm@urmc.rochester.edu.
Arthur J
AJ
Moss
University of Rochester Medical Center.
David
D
Oakes
University of Rochester Medical Center.
Daniel H
DH
Ryan
Aalborg University Hospital, Aalborg, Denmark.
Poul E
PE
Bloch Thomsen
University of Rochester Medical Center.
Wojciech
W
Zareba
D002309:Cardiology / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D058996:Quality Improvement