• heart valve prosthesis implantation

Guidelines are increasingly being used and quoted in everyday clinical practice. They are often promoted as a binary decision tool and increasingly form the basis of quality improvement programmes in the belief that following guidelines will improve patient care. To choose not to follow guideline recommendations can therefore lead to criticisms and questions regarding the adequacy and quality of care. However, rigorous application and strict implement of guidelines can lead to poor quality care for many patients. Clinical decision-making is rarely simplistic and binary. Shared decision-making with the patient is all important and should be at the centre of our practice. Furthermore, recommendations are only as good as the guideline. Some societies continue to believe that expert opinion has primacy and should dictate guideline content and its recommendations. This methodology is often performed in the absence of systematic or structured clinical evidence synthesis and evaluation. Many observers have increasingly challenged this approach which is becoming outdated.1 2 Expert opinion-based guidelines urgently need to change and to evolve to make themselves more credible, reliable and professional.

Lamelas and colleagues present a clinical practice guideline focused on the use and selection of surgical aortic valve replacement or transcatheter aortic valve implantation.3 This was endorsed by the South American cardiology societies: Sociedad Latino Americana de Cardiologia Intervencionista and the Sociedad Interamericana de Cardiologia. Interestingly, the authors also included representation from McMaster University in Canada presumably providing methodological support for the development of the guideline. We commend and applaud the authors and the guideline …