• practice guidelines

Clinical practice guidelines are consensus statements systematically developed to help physicians, and ultimately patients, make decisions about appropriate health care for specific clinical circumstances. Over 20 years ago the American College of Cardiology (ACC) and the American Heart Association (AHA) established a joint task force to define the role of specific, non-invasive and invasive procedures in the diagnosis and management of cardiovascular disease.¹ More specifically, this was initially aimed at establishing the appropriate utilisation of technology in the diagnosis and treatment of cardiovascular patients and was initially directed towards the development of guidelines for permanent cardiac pacemaker implantation. Subsequently, task forces have played an important role in developing other guidelines for a host of cardiovascular, medical, and surgical conditions as well as diagnostic procedures. Using rules of evidence and clinical recommendations originally developed by Sackett for the use of antithrombotic agents, a relatively systematic approach (see box) towards the generation of guidelines has emerged.² Framed by three levels of evidence, recommendations are categorised as: (1) data derived from multiple randomised clinical trials; (2) data derived from a single randomised trial or non-randomised studies; and (3) where data does not exist but a consensus opinion is developed from a variety of experts.