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Guideline-Directed Medical Therapy—Recognizing advances in medical therapy across the spectrum of cardiovascular diseases, the Task Force designated the term “guideline-directed medical therapy” (GDMT) to represent recommended medical therapy as defined mainly by Class I measures—generally a combination of lifestyle modification and drug- and device-based therapeutics.As medical science advances, GDMT evolves, and hence GDMT is preferred to “optimal medical therapy.” For GDMT and all other recommended drug treatment regimens, the reader should confirm the dosage with product insert material and carefully evaluate for contraindications and possible drug interactions.
Evidence Review—Guideline writing committee (GWC) members are charged with reviewing the literature; weighing the strength and quality of evidence for or against particular tests, treatments, or procedures; and estimating expected health outcomes when data exist.Practical considerations, including time and resource constraints, limit the ERCs to addressing key clinical questions for which the evidence relevant to the guideline topic lends itself to systematic review and analysis when the systematic review could impact the sense or strength of related recommendations.The GWC develops recommendations on the basis of the systematic review and denotes them with superscripted “SR” (i.e., ) to emphasize support derived from formal systematic review.Clinical Implementation—Management in accordance with CPG recommendations is effective only when followed; therefore, to enhance the patient’s commitment to treatment and compliance with lifestyle adjustment, clinicians should engage the patient to participate in selecting interventions on the basis of the patient’s individual values and preferences, taking associated conditions and comorbidities into consideration (e.g., shared decision making).Consequently, there are circumstances in which deviations from these CPGs are appropriate.Individualizing Care in Patients With Associated Conditions and Comorbidities—The ACC and AHA recognize the complexity of managing patients with multiple conditions, compared with managing patients with a single disease, and the challenge is compounded when CPGs for evaluation or treatment of several coexisting illnesses are discordant or interacting (7).
CPGs attempt to define practices that meet the needs of patients in most, but not all, circumstances and do not replace clinical judgment.
In analyzing the data and developing CPGs, the GWC uses evidence-based methodologies developed by the Task Force (6).
A key component of the ACC/AHA CPG methodology is the development of recommendations on the basis of all available evidence.
The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients.
Since 1980, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health.
Concurrently, the Level of Evidence (LOE) rates the scientific evidence supporting the effect of the intervention on the basis of the type, quality, quantity, and consistency of data from clinical trials and other reports (Table 1) (4).