Welcome to Lesson 1 of this learning activity titled, Understanding Metrics, Development of Guidelines. The content in this lesson was developed by Denise Pond and Beth Denton. I'm Veronica Wilson, and I will be narrating this lesson. The American College of Cardiology, or ACC, and the American Heart Association, or AHA, have a joint task force on clinical practice guidelines, which provides treatment guidance for the specialty of cardiology. This ensures consistent treatment of patients and optimized cardiovascular care with one voice. The task force determines what guidelines will be developed and updated. The ACC-AHA task force adheres to a rigorous process for updating the clinical practice guidelines. Preparations for the biannual meetings begin months in advance. ACC-AHA joint staff are responsible for compiling evidence from late-breaking clinical trials, or LBCTs, as well as other pertinent data. Task force members review evidence and rate significance on the data by specialty area. Some information may cross content areas, such as the heart failure and atrial fibrillation guidelines. In addition to scientific rigor, the ACC-AHA task force considers guideline writing committee formation a critical part of the process. Extensive vetting ensures that scientific leaders on the committee are diverse in a variety of ways, such as geographic location, gender, background, specialty, and practice vetting. This diversity allows for a broad perspective on the topic. To ensure and maintain objectivity, the guideline chair must be without any relationships with industry for 12 months prior to becoming the chair and for the duration of the guideline development process. These criteria also apply to greater than 50% of the guideline writing committee members. The guideline writing committee evaluates new evidence using the class or strength of recommendations. The class of recommendations portion of the table is a way to understand the strength of a recommendation. The class ranges from 1, which is the strongest, to 3, which is the weakest and may cause harm. The benefit-to-risk ratio is shown for each class. Depending on the class of the recommendation, the writing committee will use special phrases to guide the clinician in the treatment of the patient. Class 1 is a strong recommendation as it is indicated and should be performed. Class 2A has moderate strength and is reasonable as it can be beneficial. Class 2B is a weak recommendation, which might be reasonable or considered. Class 3, no benefit, indicates that the benefit is equal to the risk and is not recommended and should not be performed. Class 3, harm, indicates that the risk outweighs the benefits and is potentially harmful. Additionally, the guideline writing committee evaluates new evidence using the level or quality of evidence, or LOE. The level of evidence portion of this table explains the quality of the evidence. The data comes from a variety of sources and can be categorized into five groups. Level A has high quality evidence from one or more randomized clinical trials. Level B-R has moderate quality evidence from one or more randomized clinical trials. Level B-N-R has moderate quality evidence from one or more well-designed and executed non-randomized observational or registry studies. Level C-L-D has evidence from randomized or non-randomized observational or registry studies with limited design or data. Finally, level C-E-O is based on expert opinion and clinical experience. After the writing committee completes their task, the document is sent to peer reviewers who are content experts in the topic area. Reviewers send in their comments and then the document undergoes revision based on the comments. Once the updates are completed, the writing committee reviews the content again. The document then undergoes review and approval by the leaders of the ACC and AHA. Upon publication, the ACC-AHA Clinical Practice Guidelines are available at acc.org. Once you're on ACC's homepage, click on Guidelines at the center of the top line of the homepage. The guidelines are free for review or download to clinicians and the public. The National Cardiovascular Data Registry, or NCDR, includes guideline metrics as part of their suite of registries. The use of evidence-based metrics has been shown to drive quality improvement. Guideline metrics are important because they assist clinicians with clinical decision making, they improve patient outcomes, they reduce practice variation, they synthesize the latest clinical research, and they provide a basis for the development of performance measures. In the next few lessons, we will discuss specific guideline metrics. This concludes Lesson 1 of Understanding Guideline Metrics with emphasis on the development of the guidelines. Thank you for your participation.

Understanding Metrics

Development of Guidelines

American College of Cardiology

American Heart Association

clinical practice guidelines