Key PointsQuestion
What proportion of recommendations in current American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines are supported by evidence from multiple randomized controlled trials (RCTs), and how has this changed over the past 10 years?
Findings
In this systematic review of 51 current guideline documents that included 6329 recommendations, 8.5% of recommendations in ACC/AHA guidelines and 14.3% of recommendations in ESC guidelines were classified as level of evidence A (supported by evidence from multiple RCTs), compared with 11.5% of recommendations in a systematic review of ACC/AHA guidelines conducted in 2009.
Meaning
Among recommendations in major cardiovascular society guidelines from 2008 to 2018, the proportion supported by evidence from RCTs remains small.
Importance
Clinical decisions are ideally based on evidence generated from multiple randomized controlled trials (RCTs) evaluating clinical outcomes, but historically, few clinical guideline recommendations have been based entirely on this type of evidence.
Objective
To determine the class and level of evidence (LOE) supporting current major cardiovascular society guideline recommendations, and changes in LOE over time.
Data Sources
Current American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) clinical guideline documents (2008-2018), as identified on cardiovascular society websites, and immediate predecessors to these guideline documents (1999-2014), as referenced in current guideline documents.
Study Selection
Comprehensive guideline documents including recommendations organized by class and LOE.
Data Extraction and Synthesis
The number of recommendations and the distribution of LOE (A [supported by data from multiple RCTs or a single, large RCT], B [supported by data from observational studies or a single RCT], and C [supported by expert opinion only]) were determined for each guideline document.
Main Outcomes and Measures
The proportion of guideline recommendations supported by evidence from multiple RCTs (LOE A).
Results
Across 26 current ACC/AHA guidelines (2930 recommendations; median, 121 recommendations per guideline [25th-75th percentiles, 76-155]), 248 recommendations (8.5%) were classified as LOE A, 1465 (50.0%) as LOE B, and 1217 (41.5%) as LOE C. The median proportion of LOE A recommendations was 7.9% (25th-75th percentiles, 0.9%-15.2%). Across 25 current ESC guideline documents (3399 recommendations; median, 130 recommendations per guideline [25th-75th percentiles, 111-154]), 484 recommendations (14.2%) were classified as LOE A, 1053 (31.0%) as LOE B, and 1862 (54.8%) as LOE C. When comparing current guidelines with prior versions, the proportion of recommendations that were LOE A did not increase in either ACC/AHA (median, 9.0% [current] vs 11.7% [prior]) or ESC guidelines (median, 15.1% [current] vs 17.6% [prior]).
Conclusions and Relevance
Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT. This pattern does not appear to have meaningfully improved from 2008 to 2018.
In the late 1980s and early 1990s, evidence-based medicine, an approach that stresses the use of evidence from clinical research in clinical decision making, supplanted an older paradigm that valued accumulated wisdom and experience derived from unsystematic observation.1 Randomized controlled trials (RCTs), especially those that evaluate important clinical outcomes, and meta-analyses combining their results, represent the pinnacle of evidence under this framework because the randomization process attempts to equalize the distribution of unmeasured and unknown confounders, enabling investigators to compare competing treatments or strategies with the lowest risk of confounding.
Clinical guidelines for the care of patients with cardiovascular diseases, released by the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) for more than 30 years, have integrated the evidence-based medicine framework by assigning a level of evidence (LOE) to each recommendation. Each recommendation is assigned an LOE that indicates whether the recommendation is based on multiple RCTs or a single, large RCT (LOE A), observational studies or a single RCT (LOE B), or expert opinion only (LOE C). Across a number of cardiovascular subfields, adherence to guideline recommendations translates the treatment benefits demonstrated in high-quality RCTs to improved patient outcomes.2-4
In a review of the ACC/AHA clinical practice guidelines from 2009, only 11% of recommendations were classified as LOE A.5 The authors called for greater collaboration among investigators and funders in identifying key research questions, development of streamlined clinical trial methods, and expansion of funding for clinical research. In the intervening years, some of these steps have been taken,6-8 but it is not known whether they have improved the evidence supporting cardiovascular guideline recommendations. This systematic review of current ACC/AHA and ESC guidelines and their immediate precursors was conducted to describe the evidence behind current guideline recommendations and changes in evidence over recent years.
Current ACC/AHA guidelines were identified as those posted on the ACC (https://www.acc.org/guidelines#doctype=Guidelines) and ESC (https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines) websites as of February 1, 2019. Only comprehensive guideline documents were included in this systematic review; expert consensus documents, performance measures, and appropriateness criteria were not included because they do not report LOE. Focused updates were not included because they are not representative of the evidence base for an entire topic. Only guideline documents that included recommendations organized by class and LOE, clearly highlighted and separated from the rest of the text, were included for this analysis.
Current guideline documents were downloaded, and recommendations were abstracted by a single reviewer (A.C.F.) and validated by another reviewer (R.D.L). The reviewers recorded the number of recommendations included in each document, as well as the LOE (supported by data from multiple RCTs or a single, large RCT [LOE A]; supported by data from observational studies or a single RCT [LOE B]; supported by expert opinion only [LOE C]) and class for each. All recommendations are given a class that synthesizes the opinion of the guideline writing committee regarding the risks and benefits identified by the evidence and expert opinion. Class I recommendations are those for which there is evidence, general agreement, or both, that the treatment is useful or effective. Class IIa recommendations are those for which there is conflicting evidence or opinion, but the weight of evidence/opinion is in favor of the treatment’s usefulness, efficacy, or both; class IIb recommendations are those for which usefulness or efficacy is less well established. Class III recommendations are those for which there is evidence or general agreement that the treatment is not useful or effective and may be harmful.
Current guidelines were also reviewed to identify references to a previous iteration of the same guideline; for example, the 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes was preceded by the 2007 ACC/AHA Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction.9,10 These previous iterations were then downloaded and abstracted, if they otherwise met inclusion criteria.
Recommendations in included guideline documents are clearly displayed statements highlighted and separated from the rest of the document text. Each recommendation has a clearly designated class of recommendation and LOE. Abstraction therefore involved simple reporting of the content of each document and did not require judgment on the part of the abstractors.
We report the number of recommendations classified as LOE A, B, and C for each current guideline document, as well as the proportion of LOE A, B, and C recommendations by class. Because the number of recommendations included in a guideline document differ substantially by topic, we present the median proportion of recommendations with LOE A, B, and C for ACC/AHA guidelines and for ESC guidelines. We also categorized guideline documents by cardiovascular subspecialty area (electrophysiology, coronary artery disease, heart failure and myocardial disease, congenital and valvular heart disease, vascular medicine, preventive and general outpatient cardiology) and report the proportion of recommendations for each subspecialty area categorized as LOE A overall and by class of recommendation. We further report the median proportion of recommendations with LOE A, B, and C among guideline documents in each subspecialty area.
To identify changes in quality of evidence over time among current guidelines, we report the proportion of recommendations categorized as LOE A by year of guideline document release (2017-2018, 2015-2016, 2013-2014, and before 2014). We also report the proportion of recommendations categorized as LOE A in guideline documents released in the past 2 years (2017-2018) and those released before 2017. To further evaluate whether there has been a change in the evidence underpinning guideline recommendations, we compared the proportion of LOE A, B, and C recommendations in current guidelines with the proportion in prior guidelines. This procedure was performed separately for ACC/AHA and ESC guidelines. For topics that had both a current ACC/AHA and a current ESC guideline, we report the proportion of LOE A recommendations by society producing the guideline overall and by subspecialty area.
Overall, LOEs from 26 current ACC/AHA guidelines (2930 recommendations) published between 2008 and 2018,10-35 and from 25 current ESC guidelines (3399 recommendations) published between 2003 and 2018, were abstracted.36-60
Across the 26 current ACC/AHA guidelines, 248 recommendations (8.5%) were classified as LOE A, 1465 (50.0%) as LOE B, and 1217 (41.5%) as LOE C (eTable 1 in the Supplement). Of 1272 class I recommendations, 180 (14.2%) were classified as LOE A. The median number of recommendations per guideline was 121 (25th-75th percentiles, 76-155), of which 7.9% (25th-75th percentiles, 0.9%-15.2%) were LOE A, 50.1% (25th-75th percentiles, 40.9%-58.4%) were LOE B, and 38.4% (25th-75th percentiles, 31.2%-49.0%) were LOE C. When guidelines were categorized by subspecialty area, the proportion of recommendations characterized as LOE A ranged from 2.0% (valvular and congenital heart disease) to 14.5% (general cardiology) (Figure 1, panel A). Overall, 1604 recommendations were classified as class I (“should do”) or class III (“should not do”). Of these recommendations, 207 (12.9%) were supported by LOE A evidence, 785 (48.9%) by LOE B evidence, and 612 (38.2%) by LOE C evidence.
Since 2015, ACC/AHA guidelines have indicated whether recommendations with LOE B were based on data from RCTs or observational studies. In the 8 guideline documents published since,11-16,34,35 there were a total of 543 recommendations with LOE B, and 144 of these recommendations (26.5%) were based on data from RCTs.
Across the 25 current ESC guidelines, 484 recommendations (14.2%) were classified as LOE A, 1053 (31.0%) as LOE B, and 1862 (54.8%) as LOE C. Of 1622 class I recommendations, 349 (21.5%) were LOE A. The median number of guideline recommendations was 130 (25th-75th percentiles, 111-154), of which 9.1% (25th-75th percentiles, 3.8%-23.1%) were LOE A, 32.6% (25th-75th percentiles, 20.5%-38.9%) were LOE B, and 50.0% (25th-75th percentiles, 40.3%-72.7%) were LOE C (eTable 2 in the Supplement). When guidelines were categorized by subspecialty area, the proportion of recommendations characterized as LOE A ranged from 2.5% (valvular and congenital heart disease) to 25.0% (general cardiology) (Figure 1, panel B). ESC guidelines contained 1884 class I and class III recommendations, 402 (21.3%) classified as LOE A, 548 (29.1%) as LOE B, and 934 (49.6%) as LOE C.
To identify trends over time, we compared evidence supporting recommendations from guideline documents written in the past 2 years (2017-2018) with that from other current guideline documents. In ACC/AHA guidelines, 5.7% of recommendations released in the past 2 years were supported by LOE A evidence compared with 9.5% of recommendations released earlier (eFigure in the Supplement). In ESC guidelines, 17.4% of recommendations released in the past 2 years were supported by LOE A evidence, compared with 12.8% of recommendations released earlier.
Changes From Prior to Current Guidelines
Sixteen current ACC/AHA guideline documents, published between 2008 and 2018, had a prior document for comparison.10,12,14-17,19,21,23-28,33,34 These 16 documents contained a total of 2159 recommendations (median, 130). The 16 prior documents were published between 1999 and 2013 and included 3154 recommendations (median, 135).9,59,61-74
Among the 16 current ACC/AHA guideline documents with available prior guideline documents, the median proportion of LOE A recommendations was 9.0% (25th-75th percentiles, 4.8%-15.1%); the median proportion of LOE A recommendations in prior guidelines was 11.7% (25th-75th percentiles, 5.8%-17.5%) (Figure 2, panel A). Among class I recommendations, there was similarly no meaningful change in the proportion that were LOE A between current and prior guidelines (median, 16.1% in current vs 20.7% in prior). By contrast, when comparing the proportion of LOE B and C recommendations in prior ACC/AHA guidelines and current guidelines, the proportion of LOE B recommendations increased (median, 41.9% vs 51.0%) and the proportion of LOE C recommendations decreased (median, 51.9% vs 36.7%).
When looking at number rather than proportion of LOE A recommendations, findings were similar: The median number of LOE A recommendations in prior guidelines was 10.5 (25th-75th percentiles, 7.5-28.0) compared with 11.5 (25th-75th percentiles, 6.5-16.0) in current guidelines, and in 10 of 16 current/prior guideline dyads, there were more LOE A recommendations in the prior iteration of the guidelines.
Sixteen current ESC guideline documents, published between 2014 and 2018, had a corresponding prior guideline document for comparison.36-51 These 16 documents included 2447 recommendations (median, 142). The 16 prior documents were published between 2004 and 2014 and included 2112 recommendations (median, 110).42,64,75-88
Among the 16 current ESC guideline documents with available prior guideline documents, the median proportion of LOE A recommendations was 15.1% (25th-75th percentiles, 3.7%-26.4%); the median proportion of LOE A recommendations among prior guidelines was 17.6% (25th-75th percentiles, 2.4%-27.6%) (Figure 2, panel B). Among class I recommendations, there was similarly little change in the proportion that were LOE A between current and prior guidelines (median, 26.9% in current vs 23.6% in prior). There were similarly small differences between current and prior guidelines in the proportion of recommendations that were LOE B (median, 31.7% [current] vs 33.4% [prior]) or LOE C (median, 49.3% [current] vs 48.0% [prior]).
When looking at number of recommendations, the median number of LOE A recommendations in current guideline documents was 21 (25th-75th percentiles, 4.7-37.2), compared with 26 (25th-75th percentiles, 2.5-35.2) in prior guideline documents.
Comparison Between ACC/AHA and ESC Guidelines
Among current guideline documents, 17 topics had both a current ESC and current ACC/AHA version. Among these guideline documents, 13.3% of recommendations in ESC guidelines and 7.5% of recommendations in ACC/AHA guidelines were supported by LOE A evidence. In 13 cases, the ESC guideline document had a greater proportion of recommendations supported by LOE A evidence. When guideline documents were grouped by subspecialty, ESC guidelines included a greater proportion of recommendations classified as LOE A in every subspecialty area except valvular and congenital heart disease (Figure 3). A greater proportion of recommendations in ESC guidelines, both current and prior, were class I, LOE A than in ACC/AHA guidelines (Figure 4).
In this review of evidence supporting major society cardiovascular guidelines, less than 10% of recommendations from current ACC/AHA guidelines and less than 15% of recommendations from current ESC guidelines were supported by evidence from multiple high-quality RCTs and characterized as LOE A; approximately 80% of strong (class I or III) recommendations were not characterized as LOE A. Furthermore, there was wide variety by subject area—in some guideline documents, more than 33% of recommendations were characterized as LOE A, but others had no LOE A recommendations at all. Among guideline documents that have been updated, there was no meaningful change in the proportion or number of recommendations characterized as LOE A from prior to current guidelines. Taken together, these results demonstrate that efforts over the past decade to simplify and facilitate clinical trials have not yet translated into an evidence base better supported by RCTs.
In 2009, Tricoci et al5 analyzed data from ACC/AHA guidelines published from 1984 to 2008. At that time, 12% of guideline recommendations were classified as LOE A, including 19% of class I recommendations. Because LOEs were included in guidelines starting in 1998, Tricoci et al were only able to assess changes in LOE over time in 6 guideline documents, but in these 6 guideline documents, they found minimal increases in LOE A recommendations compared with LOE B and C. In follow-up to this effort, the evidence underlying guideline recommendations in other medical and surgical subspecialties was systematically reviewed in a number of studies. Overall, very few recommendations were supported by high-quality evidence from multiple RCTs.89-99
In the article by Tricoci et al, the authors pointed out many of the flaws in the clinical trial enterprise, including inefficiency, fragmentation, and reliance on industry funding, resulting in narrowly focused trials in highly selected populations, designed to achieve regulatory approval but not necessarily to provide useful evidence for patients, clinicians, and payers. The authors called for increased funding for practical clinical trials evaluating the comparative effectiveness of existing products, increased collaboration in setting a research agenda, and novel methods of conducting clinical trials with less waste. Over the last decade, public-private partnerships have been developed to fund clinical trials asking patient-centered questions,7 trial designs leveraging administrative data and existing registries to capture baseline characteristics and long-term outcomes have been deployed in service to these questions,6,100,101 and a series of meetings have brought leaders in various cardiovascular subfields together to collaboratively devise research agendas.102,103
The present study shows that, despite these efforts, the proportion of guideline recommendations supported by high-quality evidence did not increase. When directly comparing current guideline documents with prior documents covering the same topic there was similarly not a meaningful increase in recommendations with LOE A classification from the prior version to the current version of guidelines in either the ACC/AHA or ESC guidelines. Although it is possible that RCTs both convincingly answer a single question (leading to a single LOE A recommendation) and raise new questions (leading to multiple non–LOE A recommendations), the absolute number of LOE A recommendations did not meaningfully change from prior to current guideline iterations. In both the ACC/AHA and the ESC guidelines, the large majority of patient care recommendations were based on nonrandomized evidence, even class I (“should do”) and class III (“should not do”) recommendations. The lack of RCT evidence supporting most recommendations in the guidelines was compounded by variability among subspecialties within cardiovascular medicine; some subspecialty guidelines contained almost no LOE A recommendations. Although the ESC and ACC/AHA guidelines use similar evidence to generate recommendations, a greater proportion of recommendations overall in the ESC guidelines were classified as LOE A, highlighting differences in the way that these professional societies interpret data and make guideline recommendations, and/or hesitancy of guideline writing committees to categorize as LOE A recommendations based on evidence from RCTs that enrolled patients entirely in other regions of the world.
In the ACC/AHA guidelines, there was a small increase in the proportion of recommendations that were LOE B and a decrease in the proportion that were LOE C when comparing current and prior guideline documents. LOE B recommendations are supported either by observational studies or single RCTs, so this increase in LOE B recommendations could indicate that the proportion of recommendations supported by randomized evidence is increasing; however, relatively few LOE B recommendations were supported by randomized evidence. More likely, the increase in LOE B recommendations from prior to current ACC/AHA guideline documents can be explained, at least in part, by the elaboration of new observational “big data” sources and application of advanced statistical methods, which have led researchers to ask and answer questions using observational study designs.104 Although evidence generated from such studies is valuable in many circumstances, comparative effectiveness analyses using observational data are limited by residual confounding, and in most circumstances a well-conducted RCT is the only study design that enables a true comparison (and cause-effect relationship assessment) between 2 medications, procedures, or treatment strategies.104 In a review of cardiology guidelines, 19% of class I recommendations supported by 1 RCT or observational evidence only, and more than 25% of class I recommendations supported by expert opinion only, were downgraded or reversed in the next edition of the guidelines, compared with less than 10% of recommendations supported by higher-quality evidence.105
Solid RCT evidence delineates treatments and strategies that lead to better patient outcomes, which can then be implemented in clinical practice.106 By contrast, in the absence of RCT evidence, the association between clinical practices and outcomes is less certain. The decline in cardiovascular mortality has decelerated over the past several years.107 Efforts to bolster the evidence base—eg, pragmatic clinical trials, registry-based clinical trials, and clinical trials conducted within health systems—may help forestall this trend.
This study has several limitations. First, the evidence supporting major society guideline recommendations is a surrogate for the totality of the evidence in cardiology, rather than a direct measurement. The quality of evidence supporting each recommendation was not independently assessed, and it is possible that an increasing proportion of LOE B recommendations are supported by RCT evidence that is insufficient to characterize as LOE A. Similarly, the proportion of guideline recommendations supported by LOE A evidence may not be a perfect surrogate for the totality of evidence, because advances in the field may make prior guideline recommendations obsolete and thus removed from the next edition of the guidelines. Alternatively, standards for LOE A designation may have changed over time.
Second, exclusion of focused updates, which are usually undertaken when new RCT evidence is generated, may lead to underestimation of the proportion of LOE A recommendations; however, this limitation should not affect findings regarding changes in LOE over time.
Third, this review describes only evidence supporting cardiology guidelines, rather than across medical and surgical subspecialties; however, prior studies have shown a low level of high-quality evidence in other fields. Moreover, the high global prevalence of cardiovascular disease suggests that efforts to build a higher-quality cardiovascular medicine evidence base might have a large effect on global health.
Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT. This pattern does not appear to have meaningfully improved from 2008 to 2018.
Corresponding Author: Renato D. Lopes, MD, PhD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715 (renato.lopes@duke.edu).
Accepted for Publication: February 12, 2019.
Author Contributions: Drs Fanaroff and Lopes had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Fanaroff, Smith, Lopes.
Acquisition, analysis, or interpretation of data: Fanaroff, Califf, Windecker, Lopes.
Drafting of the manuscript: Fanaroff, Lopes.
Critical revision of the manuscript for important intellectual content: Fanaroff, Califf, Windecker, Smith, Lopes.
Statistical analysis: Fanaroff, Lopes.
Obtained funding: Lopes.
Administrative, technical, or material support: Califf, Lopes.
Supervision: Lopes.
Conflict of Interest Disclosures: Dr Fanaroff reported support from a career development grant from the American Heart Association (17FTF33661087). Dr Califf reported serving as the Commissioner of Food and Drugs for the US Food and Drug Administration from February 2016 to January 2017; serving as Deputy Commissioner for Medical Products and Tobacco for the US Food and Drug Administration from February 2015 to January 2016; serving on the corporate board for Cytokinetics and as board chair for the People-Centered Research Foundation; and receiving consulting fees from Merck, Biogen, Genentech, Eli Lilly, and Boehringer Ingelheim. Dr Windecker reported research and educational grants to his institution from Abbott, Amgen, Bayer, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, St Jude, and Terumo. Dr Lopes reported receiving research grants from Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi and receiving personal fees from Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. Dr Smith reported no disclosures.
2.Mehta
RH, Chen
AY, Alexander
KP, Ohman
EM, Roe
MT, Peterson
ED. Doing the right things and doing them the right way: association between hospital guideline adherence, dosing safety, and outcomes among patients with acute coronary syndrome.
Circulation. 2015;131(11):980-987. doi:
10.1161/CIRCULATIONAHA.114.013451PubMedGoogle ScholarCrossref 3.Komajda
M, Cowie
MR, Tavazzi
L, Ponikowski
P, Anker
SD, Filippatos
GS; QUALIFY Investigators. Physicians’ guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry.
Eur J Heart Fail. 2017;19(11):1414-1423. doi:
10.1002/ejhf.887PubMedGoogle ScholarCrossref 4.Lip
GY, Laroche
C, Popescu
MI,
et al. Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry.
Europace. 2015;17(12):1777-1786. doi:
10.1093/europace/euv269PubMedGoogle ScholarCrossref 9.Anderson
JL, Adams
CD, Antman
EM,
et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction); American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association of Cardiovascular and Pulmonary Rehabilitation; Society for Academic Emergency Medicine. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction.
J Am Coll Cardiol. 2007;50(7):e1-e157. doi:
10.1016/j.jacc.2007.02.013PubMedGoogle ScholarCrossref 10.Amsterdam
EA, Wenger
NK, Brindis
RG,
et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
J Am Coll Cardiol. 2014;64(24):e139-e228. doi:
10.1016/j.jacc.2014.09.017PubMedGoogle ScholarCrossref 11.Whelton
PK, Carey
RM, Aronow
WS,
et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/Pcna Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
J Am Coll Cardiol. 2018;71(19):e127-e248. doi:
10.1016/j.jacc.2017.11.006PubMedGoogle ScholarCrossref 12.Stout
KK, Daniels
CJ, Aboulhosn
JA,
et al. AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online August 10, 2019].
J Am Coll Cardiol. 2018. doi:
10.1161/CIR.0000000000000602Google Scholar 13.Shen
WK, Sheldon
RS, Benditt
DG,
et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
J Am Coll Cardiol. 2017;70(5):e39-e110. doi:
10.1016/j.jacc.2017.03.003PubMedGoogle ScholarCrossref 14.Gerhard-Herman
MD, Gornik
HL, Barrett
C,
et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
J Am Coll Cardiol. 2017;69(11):e71-e126. doi:
10.1016/j.jacc.2016.11.007PubMedGoogle ScholarCrossref 15.Al-Khatib
SM, Stevenson
WG, Ackerman
MJ,
et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
J Am Coll Cardiol. 2018;72(14):e91-e220. doi:
10.1016/j.jacc.2017.10.054PubMedGoogle ScholarCrossref 16.Page
RL, Joglar
JA, Caldwell
MA,
et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
J Am Coll Cardiol. 2016;67(13):e27-e115. doi:
10.1016/j.jacc.2015.08.856PubMedGoogle ScholarCrossref 17.Nishimura
RA, Otto
CM, Bonow
RO,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.
J Am Coll Cardiol. 2014;63(22):e57-e185. doi:
10.1016/j.jacc.2014.02.536PubMedGoogle ScholarCrossref 18.Jensen
MD, Ryan
DH, Apovian
CM,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.
J Am Coll Cardiol. 2014;63(25, pt B):2985-3023. doi:
10.1016/j.jacc.2013.11.004PubMedGoogle ScholarCrossref 19.January
CT, Wann
LS, Alpert
JS,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation.
J Am Coll Cardiol. 2014;64(21):e1-e76. doi:
10.1016/j.jacc.2014.03.022PubMedGoogle ScholarCrossref 20.Goff
DC
Jr, Lloyd-Jones
DM, Bennett
G,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.
J Am Coll Cardiol. 2014;63(25, pt B):2935-2959. doi:
10.1016/j.jacc.2013.11.005PubMedGoogle ScholarCrossref 21.Fleisher
LA, Fleischmann
KE, Auerbach
AD,
et al; American College of Cardiology; American Heart Association. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery.
J Am Coll Cardiol. 2014;64(22):e77-e137. doi:
10.1016/j.jacc.2014.07.944PubMedGoogle ScholarCrossref 22.Eckel
RH, Jakicic
JM, Ard
JD,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk.
J Am Coll Cardiol. 2014;63(25, pt B):2960-2984. doi:
10.1016/j.jacc.2013.11.003PubMedGoogle ScholarCrossref 23.Yancy
CW, Jessup
M, Bozkurt
B,
et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA Guideline for the Management of Heart Failure.
J Am Coll Cardiol. 2013;62(16):e147-e239. doi:
10.1016/j.jacc.2013.05.019PubMedGoogle ScholarCrossref 24.O’Gara
PT, Kushner
FG, Ascheim
DD,
et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
J Am Coll Cardiol. 2013;61(4):e78-e140. doi:
10.1016/j.jacc.2012.11.019PubMedGoogle ScholarCrossref 25.Fihn
SD, Gardin
JM, Abrams
J,
et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease.
J Am Coll Cardiol. 2012;60(24):e44-e164. doi:
10.1016/j.jacc.2012.07.013PubMedGoogle ScholarCrossref 27.Levine
GN, Bates
ER, Blankenship
JC,
et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention.
J Am Coll Cardiol. 2011;58(24):e44-e122. doi:
10.1016/j.jacc.2011.08.007PubMedGoogle ScholarCrossref 28.Hillis
LD, Smith
PK, Anderson
JL,
et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; Society of Cardiovascular Anesthesiologists; Society of Thoracic Surgeons. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery.
J Am Coll Cardiol. 2011;58(24):e123-e210. doi:
10.1016/j.jacc.2011.08.009PubMedGoogle ScholarCrossref 29.Gersh
BJ, Maron
BJ, Bonow
RO,
et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy.
J Am Coll Cardiol. 2011;58(25):e212-e260. doi:
10.1016/j.jacc.2011.06.011PubMedGoogle ScholarCrossref 30.Brott
TG, Halperin
JL, Abbara
S,
et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery.
J Am Coll Cardiol. 2011;57(8):e16-e94. doi:
10.1016/j.jacc.2010.11.006PubMedGoogle ScholarCrossref 31.Hiratzka
LF, Bakris
GL, Beckman
JA,
et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease.
J Am Coll Cardiol. 2010;55(14):e27-e129. doi:
10.1016/j.jacc.2010.02.015PubMedGoogle ScholarCrossref 32.Greenland
P, Alpert
JS, Beller
GA,
et al; American College of Cardiology Foundation; American Heart Association. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults.
J Am Coll Cardiol. 2010;56(25):e50-e103. doi:
10.1016/j.jacc.2010.09.001PubMedGoogle ScholarCrossref 33.Epstein
AE, DiMarco
JP, Ellenbogen
KA,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices); American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities.
J Am Coll Cardiol. 2008;51(21):e1-e62. doi:
10.1016/j.jacc.2008.02.032PubMedGoogle ScholarCrossref 34.Grundy
SM, Stone
NJ, Bailey
AL,
et al. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol [published online November 10, 2018].
J Am Coll Cardiol. 2018. doi:
10.1016/j.jacc.2018.11.003Google Scholar 35.Kusumoto
FM, Schoenfeld
MH, Barrett
C,
et al. ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay [published online November 6, 2018].
J Am Coll Cardiol. 2018. doi:
10.1016/j.jacc.2018.10.044Google Scholar 39.Ibanez
B, James
S, Agewall
S,
et al; ESC Scientific Document Group. 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation.
Eur Heart J. 2018;39(2):119-177. doi:
10.1093/eurheartj/ehx393PubMedGoogle ScholarCrossref 41.Aboyans
V, Ricco
JB, Bartelink
MEL,
et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).
Eur Heart J. 2018;39(9):763-816. doi:
10.1093/eurheartj/ehx095PubMedGoogle ScholarCrossref 43.Roffi
M, Patrono
C, Collet
JP,
et al; ESC Scientific Document Group. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation.
Eur Heart J. 2016;37(3):267-315. doi:
10.1093/eurheartj/ehv320PubMedGoogle ScholarCrossref 49.Priori
SG, Blomström-Lundqvist
C, Mazzanti
A,
et al; ESC Scientific Document Group. 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
Eur Heart J. 2015;36(41):2793-2867. doi:
10.1093/eurheartj/ehv316PubMedGoogle ScholarCrossref 52.Kristensen
SD, Knuuti
J, Saraste
A,
et al. 2014 ESC/ESA Guidelines on Non-Cardiac Surgery: cardiovascular assessment and management: the Joint Task Force on Non-cardiac Surgery: Cardiovascular Assessment and Management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA).
Eur Heart J. 2014;35(35):2383-2431. doi:
10.1093/eurheartj/ehu282PubMedGoogle ScholarCrossref 53.Konstantinides
SV, Torbicki
A, Agnelli
G,
et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism.
Eur Heart J. 2014;35(43):3033-3069. doi:
10.1093/eurheartj/ehu283PubMedGoogle ScholarCrossref 54.Erbel
R, Aboyans
V, Boileau
C,
et al; ESC Committee for Practice Guidelines; Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.
Eur Heart J. 2014;35(41):2873-2926. doi:
10.1093/eurheartj/ehu281PubMedGoogle ScholarCrossref 55.Montalescot
G, Sechtem
U, Achenbach
S,
et al. 2013 ESC Guidelines on the Management of Stable Coronary Artery Disease: the Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology.
Eur Heart J. 2013;34(38):2949-3003. doi:
10.1093/eurheartj/eht296PubMedGoogle ScholarCrossref 56.Brignole
M, Auricchio
A, Baron-Esquivias
G,
et al. 2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy: the Task Force on Cardiac Pacing and Resynchronization Therapy of the European Society of Cardiology (ESC) developed in collaboration with the European Heart Rhythm Association (EHRA).
Eur Heart J. 2013;34(29):2281-2329. doi:
10.1093/eurheartj/eht150PubMedGoogle ScholarCrossref 57.Rydén
L, Grant
PJ, Anker
SD,
et al. ESC Guidelines on Diabetes, Pre-diabetes, and Cardiovascular Diseases developed in collaboration with the EASD: the Task Force on Diabetes, Pre-diabetes, and Cardiovascular Diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).
Eur Heart J. 2013;34(39):3035-3087. doi:
10.1093/eurheartj/eht108PubMedGoogle ScholarCrossref 58.Baumgartner
H, Bonhoeffer
P, De Groot
NM,
et al; Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC); ESC Committee for Practice Guidelines (CPG). ESC guidelines for the management of grown-up congenital heart disease (new version 2010).
Eur Heart J. 2010;31(23):2915-2957. doi:
10.1093/eurheartj/ehq249PubMedGoogle ScholarCrossref 59.Blomström-Lundqvist
C, Scheinman
MM, Aliot
EM,
et al; European Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—executive summary.
J Am Coll Cardiol. 2003;42(8):1493-1531.
PubMedGoogle ScholarCrossref 60.Elliott
PM, Anastasakis
A, Borger
MA,
et al. 2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).
Eur Heart J. 2014;35(39):2733-2779. doi:
10.1093/eurheartj/ehu284PubMedGoogle ScholarCrossref 61.Warnes
CA, Williams
RG, Bashore
TM,
et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
J Am Coll Cardiol. 2008;52(23):e143-e263. doi:
10.1016/j.jacc.2008.10.001PubMedGoogle ScholarCrossref 62.Mosca
L, Banka
CL, Benjamin
EJ,
et al; Expert Panel/Writing Group; American Heart Association; American Academy of Family Physicians; American College of Obstetricians and Gynecologists; American College of Cardiology Foundation; Society of Thoracic Surgeons; American Medical Women’s Association; Centers for Disease Control and Prevention; Office of Research on Women’s Health; Association of Black Cardiologists; American College of Physicians; World Heart Federation; National Heart, Lung, and Blood Institute; American College of Nurse Practitioners. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update.
Circulation. 2007;115(11):1481-1501. doi:
10.1161/CIRCULATIONAHA.107.181546PubMedGoogle ScholarCrossref 63.Fleisher
LA, Beckman
JA, Brown
KA,
et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery); American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Rhythm Society; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society for Vascular Surgery. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery [published correction appears in
J Am Coll Cardiol. 2008;52(9):793-794].
J Am Coll Cardiol. 2007;50(17):e159-e241. doi:
10.1016/j.jacc.2007.09.003PubMedGoogle ScholarCrossref 64.Zipes
DP, Camm
AJ, Borggrefe
M,
et al; American College of Cardiology/American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
Circulation. 2006;114(10):e385-e484. doi:
10.1161/CIRCULATIONAHA.106.178233PubMedGoogle ScholarCrossref 65.Smith
SC
Jr, Feldman
TE, Hirshfeld
JW
Jr,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention).
J Am Coll Cardiol. 2006;47(1):e1-e121. doi:
10.1016/j.jacc.2005.12.001PubMedGoogle ScholarCrossref 66.Fuster
V, Rydén
LE, Cannom
DS,
et al; European Heart Rhythm Association; Heart Rhythm Society; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—executive summary.
J Am Coll Cardiol. 2006;48(4):854-906. doi:
10.1016/j.jacc.2006.07.009PubMedGoogle ScholarCrossref 67.Bonow
RO, Carabello
BA, Chatterjee
K,
et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease); Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease.
J Am Coll Cardiol. 2006;48(3):e1-e148. doi:
10.1016/j.jacc.2006.05.021PubMedGoogle ScholarCrossref 68.Hunt
SA; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult.
J Am Coll Cardiol. 2005;46(6):e1-e82. doi:
10.1016/j.jacc.2005.08.022PubMedGoogle ScholarCrossref 69.Eagle
KA, Guyton
RA, Davidoff
R,
et al; American College of Cardiology; American Heart Association. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery.
Circulation. 2004;110(14):e340-e437.
PubMedGoogle Scholar 70.Antman
EM, Anbe
DT, Armstrong
PW,
et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).
J Am Coll Cardiol. 2004;44(3):E1-E211. doi:
10.1016/j.jacc.2004.07.014PubMedGoogle ScholarCrossref 71.Gregoratos
G, Abrams
J, Epstein
AE,
et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines).
J Am Coll Cardiol. 2002;40(9):1703-1719. doi:
10.1016/S0735-1097(02)02528-7PubMedGoogle ScholarCrossref 72.Gibbons
RJ, Chatterjee
K, Daley
J,
et al. ACC/AHA/ACP-ASIM Guidelines for the Management of Patients With Chronic Stable Angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina).
J Am Coll Cardiol. 1999;33(7):2092-2197. doi:
10.1016/S0735-1097(99)00150-3PubMedGoogle ScholarCrossref 73.Hirsch
AT, Haskal
ZJ, Hertzer
NR,
et al; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic).
Circulation. 2006;113(11):e463-e654.
PubMedGoogle ScholarCrossref 74.Stone
NJ, Robinson
JG, Lichtenstein
AH,
et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.
J Am Coll Cardiol. 2014;63(25, pt B):2889-2934. doi:
10.1016/j.jacc.2013.11.002PubMedGoogle ScholarCrossref 75.Windecker
S, Kolh
P, Alfonso
F,
et al. 2014 ESC/EACTS Guidelines on Myocardial Revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Eur Heart J. 2014;35(37):2541-2619. doi:
10.1093/eurheartj/ehu278PubMedGoogle ScholarCrossref 76.Mancia
G, Fagard
R, Narkiewicz
K,
et al. 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
Eur Heart J. 2013;34(28):2159-2219. doi:
10.1093/eurheartj/eht151PubMedGoogle ScholarCrossref 77.Steg
PG, James
SK, Atar
D,
et al; Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC). ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation.
Eur Heart J. 2012;33(20):2569-2619. doi:
10.1093/eurheartj/ehs215PubMedGoogle ScholarCrossref 78.Perk
J, De Backer
G, Gohlke
H,
et al; European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012).
Eur Heart J. 2012;33(13):1635-1701. doi:
10.1093/eurheartj/ehs092PubMedGoogle ScholarCrossref 80.Vahanian
A, Alfieri
O, Andreotti
F,
et al; Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012).
Eur Heart J. 2012;33(19):2451-2496. doi:
10.1093/eurheartj/ehs109PubMedGoogle ScholarCrossref 81.Hamm
CW, Bassand
JP, Agewall
S,
et al; ESC Committee for Practice Guidelines. ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation.
Eur Heart J. 2011;32(23):2999-3054. doi:
10.1093/eurheartj/ehr236PubMedGoogle ScholarCrossref 82.Tendera
M, Aboyans
V, Bartelink
ML,
et al; European Stroke Organisation; ESC Committee for Practice Guidelines. ESC Guidelines on the Diagnosis and Treatment of Peripheral Artery Diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries.
Eur Heart J. 2011;32(22):2851-2906. doi:
10.1093/eurheartj/ehr211PubMedGoogle ScholarCrossref 83.Regitz-Zagrosek
V, Blomstrom Lundqvist
C, Borghi
C,
et al; European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM); ESC Committee for Practice Guidelines. ESC Guidelines on the Management of Cardiovascular Diseases During Pregnancy.
Eur Heart J. 2011;32(24):3147-3197. doi:
10.1093/eurheartj/ehr218PubMedGoogle ScholarCrossref 84.Reiner
Z, Catapano
AL, De Backer
G,
et al; European Association for Cardiovascular Prevention and Rehabilitation; ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the Management of Dyslipidaemias.
Eur Heart J. 2011;32(14):1769-1818. doi:
10.1093/eurheartj/ehr158PubMedGoogle ScholarCrossref 85.Moya
A, Sutton
R, Ammirati
F,
et al; Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS). Guidelines for the Diagnosis and Management of Syncope (version 2009).
Eur Heart J. 2009;30(21):2631-2671. doi:
10.1093/eurheartj/ehp298PubMedGoogle ScholarCrossref 86.Habib
G, Hoen
B, Tornos
P,
et al; ESC Committee for Practice Guidelines; Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Guidelines on the Prevention, Diagnosis, and Treatment of Infective Endocarditis (new version 2009).
Eur Heart J. 2009;30(19):2369-2413. doi:
10.1093/eurheartj/ehp285PubMedGoogle ScholarCrossref 88.Maisch
B, Seferović
PM, Ristić
AD,
et al; Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Guidelines on the Diagnosis and Management of Pericardial Diseases executive summary.
Eur Heart J. 2004;25(7):587-610. doi:
10.1016/j.ehj.2004.02.002PubMedGoogle ScholarCrossref 95.Koh
C, Zhao
X, Samala
N, Sakiani
S, Liang
TJ, Talwalkar
JA. AASLD clinical practice guidelines: a critical review of scientific evidence and evolving recommendations.
Hepatology. 2013;58(6):2142-2152. doi:
10.1002/hep.26578PubMedGoogle ScholarCrossref 97.Feuerstein
JD, Akbari
M, Gifford
AE,
et al. Systematic review: the quality of the scientific evidence and conflicts of interest in international inflammatory bowel disease practice guidelines.
Aliment Pharmacol Ther. 2013;37(10):937-946. doi:
10.1111/apt.12290PubMedGoogle ScholarCrossref 101.Harvard Pilgrim Health Care. IMplementation of an RCT to imProve Treatment With Oral AntiCoagulanTs in Patients With Atrial Fibrillation (IMPACT-AFib). ClinicalTrials.gov website.
https://clinicaltrials.gov/ct2/show/NCT03259373. 2018. Accessed March 9, 2018.
102.Povsic
TJ, Scott
R, Mahaffey
KW,
et al. Navigating the future of cardiovascular drug development—leveraging novel approaches to drive innovation and drug discovery: summary of findings from the Novel Cardiovascular Therapeutics Conference.
Cardiovasc Drugs Ther. 2017;31(4):445-458. doi:
10.1007/s10557-017-6739-9PubMedGoogle ScholarCrossref