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Evidence, experts, trustworthy guidelines and WikiRecs
  1. Catherine M Otto1,
  2. Frederick A Spencer2,
  3. Per Olav Vandvik3
  1. 1Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2Divisions of Cardiology and Hematology/Thrombosis, McMaster University Faculty of Health Sciences, Toronto, Ontario, Canada
  3. 3Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington School of Medicine, Box 356422, Seattle, WA 98195, USA; cmotto{at}

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Clinical practice guidelines, based on the concept of evidence-based medicine, have positively impacted care of patients with cardiovascular disease, since their introduction over 30 years ago. Guidelines both ‘guide’ clinical practice and inform national and local healthcare policy. Now, a new definition for trustworthy guidelines—supported by explicit standards—is a major advance widely recognised by the guideline community, but largely unknown within the cardiology community.1

Current cardiology guidelines

Cardiology guidelines typically are developed and published by national and international professional organisations, most notably the European Society of Cardiology (ESC) and American College of Cardiology (ACC). Most cardiology guidelines address an entire disease process, such as heart failure, valvular heart disease or acute myocardial infarction, with numerous recommendations resulting in quite lengthy documents. Guideline development by organisations such as the ESC or ACC has relied on volunteer writing groups who are expected to review the published research, prepare evidence tables summarising these data, write recommendations with explanatory text and prepare clinical decision pathway flow charts.2 An oversight committee sets standards for guideline development and directs this process. Committees usually include representation from partner societies to ensure clinical expertise in various aspects of clinical care, for example, cardiologists, cardiac surgeons, anaesthesiologists and imaging experts. After committee members reach a consensus on each recommendation, a rigorous process of internal and external reviews, with revision in response to each reviewer's comment, helps ensure a robust document at the time of publication.

We all agree that these guidelines set a high standard of care for patients with cardiovascular disease and provide practical guidance for clinical cardiologists. However, the current process is no longer viable; we need a new approach. Clinical cardiology research is an actively expanding field, with more publications continuously adding to the existing evidence base. Current cardiology guideline development often falls short of meeting key standards …

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  • Competing interests CMO has participated in guideline-writing committees for the American College of Cardiology. POV is heading the non-profit MAGIC research and innovation programme. All three authors participated in the WikiRecs writing group for transcatheter aortic valve implantation in patients at intermediate surgical risk.

  • Provenance and peer review Commissioned; internally peer reviewed.

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