August 9th, 2013
The Guidelines are Dead. Long Live the Guidelines.
Following the recent surprising announcement that the National Heart, Lung, and Blood Institute would no longer issue guidelines, leaders of the American Heart Association (AHA) and the American College of Cardiology (ACC) have now announced that are “officially assuming the joint governance, management and public distribution” of the enormously influential cardiovascular prevention guidelines, including the much-delayed and much-anticipated hypertension and cholesterol guidelines (formerly known as JNC 8 and ATP IV). The ACC and AHA will also assume responsibility for guidelines on cardiovascular risk assessment, cardiovascular lifestyle interventions, and obesity.
In an editorial published in Circulation and the Journal of the American College of Cardiology, leaders of the NHLBI, AHA, and ACC provide a little more information on how the new model will work. One important announcement, that “all chairs and members of the current writing panels have been invited to continue to work together with the ACC and AHA to finalize the guidelines,” might indicate that the hypertension and cholesterol guidelines could see the light of day in the not-too-far-distant future. In June, the NHLBI’s Michael Lauer expressed confidence that these guidelines would appear in less than a year, but the AHA said that no timeline had yet been established.
More generally, the editorial states that the joint ACC/AHA Task Force on Practice Guidelines “will provide oversight and staff support, with NHLBI supporting further systematic evidence review as needed.” In addition, other “stakeholder organizations” who had been involved in the NHLBI’s efforts “will also be engaged” in the new process, according to the editorial.
Prior to the NHLBI announcement in June, the fate of the hypertension and cholesterol guidelines, both of which had been delayed for many years, had been the subject of widespread rumor, frustration, and criticism. In the statement published in June on the NHLBI website, NHLBI director Garry Gibbons wrote that “the landscape for guidelines development has changed dramatically. More effective strategies and clinical evidence are available to clinicians and patients.” He cited two reports from the Institute of Medicine (IOM) “that established new ‘best practice’ standards for generating systematic evidence reviews and developing clinical practice guidelines. The reports underscore that these are two distinct, yet related, activities that require careful intersection and coordination.”
Some observers also believe that the backlash against the U.S. Preventive Services Task Force’s mammography guidelines prompted the NIH and public officials to avoid making controversial recommendations.