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With recent collaboration among U.S. professional societies on heart failure and arrhythmia guidelines, could transatlantic accord on cardiovascular recommendations be next?
In this video exclusive from MedPage Today, Clyde W. Yancy, MD, of Northwestern University, a past president of the American Heart Association and current chair of the heart failure guidelines for the organization, addresses that question and notes some of the ways guidelines have improved in recent years.
Following is a transcript of his remarks:
We that write guidelines have the responsibility to translate data into practice and to provide a meaningful aide for care providers. Now, we function in a world that is much smaller than it used to be. So we have our European colleagues who write guidelines, and we have our American partners that write guidelines.
One of the notable things that's happened in the U.S. now is that the AHA (American Heart Association), the American College of Cardiology, and the Heart Failure Society of America, have come together to write joint guidelines on heart failure, just like the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society (HRS) have come together to write joint guidelines on arrhythmias -- this is as it should be. That means then that when these statements come forward, particularly when they are endorsed by partner organizations, they really represent the prevailing documents that can guide care.
Now, because there are processes that happen, if you will, on both sides of the Atlantic but we live in a small world, one wonders, "Well, is there any reason why we should still have two sets of guidelines? What's different about the guidelines?"
So let's talk about process, because there are a lot of specifics I could highlight. But let's talk about process. Both groups use an evidence acquisition and adjudication process that is unique. On the U.S.-based side, we now use an agnostic third party to aggregate the evidence and independently score the validity of the evidence. So we've taken evidence adjudication to a much higher bar. It's not just a group of people reading a paper and making a decision about that paper, but a structured process. We also do it according to defined-criteria questions that are pre-populating the search, some will understand it if I say the PICO process.
But even beyond that, the construct of the committee continues to evolve. Right now, the committee has 50% of all members plus one person, the chair especially, free of conflicts of interest of any sort, the chair especially. The other members are free of relevant conflicts of interest, so there is never going to be, ever again, a majority of any guideline writing committee that has relationships with industry. And increasingly, the cohort in the committee that has those relationships will get smaller and smaller, and eventually we'll have persons writing guidelines who have no relationships with the industry. That's not the case with our European colleagues. It doesn't mean their guidelines are any less relevant, but it does mean it's one important difference between the two organizations.
The other thing that I think is hardly ever fully appreciated is the cost of putting together a guideline, the cost, or direct costs, that have to do with the evidence search, the evidence adjudication, the construct of evidence tables, but it's also the cost of staff time to make certain that the templates are correct, that the committee meetings are formulated correctly. There are some hard costs -- direct and indirect -- that make it so that we can't cycle through these guidelines as quickly as one would like, because realize that the real resource is volunteer resource, individuals who have other major responsibilities. So a lot of process things there that really define some differences.
What intrigues me, though, is where we're going in the future. I think that where we're going in the future is a really, really crisp direction. The first thing we're doing is to make the guidelines even more relevant: more figures, more tables, less text, and importantly we're making all of the guideline documents now compatible with mobile platforms, tablets, smart phones, et cetera. So that will be a huge advantage that your iPhone or your Android device can actually give you immediate access to the guidelines, and you can interrogate the document according to the question you need to have answered for the patients you're seeing.
The next thing that I think is going to be very very important is that we finally are getting closer and closer to the guideline being a living document, meaning that a section of a guideline that doesn't need to be re-addressed, doesn't need to be updated, can remain as is. And only those sections that require updating can be updated. So the carry forward year-over-year will continue to represent not only what the committee has said, but truly the contemporary information necessary to know what to do.