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NHLBI adopts new collaborative partnership model for clinical practice guidelines development

Gary H. Gibbons, M.D. - June 19, 2013

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One of the core elements of the NHLBI mission is to prevent and treat heart, lung, and blood diseases through public education. Since the mid-1970s, the NHLBI's health education portfolio has included collaborative initiatives with researchers and practitioners to develop clinical practice guidelines focused on the management of risk factors for cardiovascular disease.

Six years ago, the Institute undertook an ambitious project to convene expert panels to update the guidelines on high blood cholesterol, high blood pressure, and overweight/obesity in adults and develop new reports on cardiovascular risk assessment and lifestyle modification.

In the interim, the landscape for guidelines development has changed dramatically. More effective strategies and clinical evidence are available to clinicians and patients. Additionally, the methods for guidelines development have evolved. In 2011, the Institute of Medicine (IOM) issued two reports 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.

In growing recognition of the changing landscape since the first NHLBI guidelines were released in the 1970s, the Institute convened the first of two National Heart, Lung, and Blood Advisory Council (NHLBAC) Working Groups. The first Working Group re-examined the appropriate role of the NHLBI in the generation of guidelines and evaluated the IOM's recommendations in relation to the Institute's historical approach to guidelines development.

In June 2012, the NHLBAC recommended that the Institute transition to a new model in accordance with the best practice standards established by the IOM, in which the Institute focuses its primary effort on the generation of high-quality systematic evidentiary reviews and supports the development of clinical practice guidelines through partnerships with professional societies and other organizations.

In October 2012, the second NHLBAC Working Group was convened to specifically evaluate the disposition of the pending cardiovascular disease documents given the recommendations of the previous Working Group. The NHLBAC Working Groups, which included members of the NHLBAC and the Board of External Experts, engaged in an extensive process that included consultation with a number of internal and external stakeholders.

Today, our Advisory Council affirmed the Working Group's recommendation in a public meeting.

The NHLBAC Working Group has facilitated our evaluation of the existing landscape and evolving best practices to define the best approach for the Institute to fulfill its leadership role in health education for the public. Accordingly, we plan to refocus our health education agenda on our core mission of knowledge generation and synthesis by supporting and producing rigorous systematic reviews that inform clinical practice guidelines. The systematic evidence review component of the five cardiovascular documents will be released by the NHLBI as a public resource to complement the associated publication of the corresponding clinical practice guidelines in collaboration with partner organizations that are on the frontlines of clinical practice.

We are working with the Guidelines Executive Committee, panel members, and partner organizations to ensure that the evidence reviews and practice guidelines are published in the public domain in a timely manner.

The resulting reports will be seminal documents that synthesize the state of scientific evidence around critical questions, such as the optimal approach for hypertension therapy to control blood pressure and improve health outcomes, and lifestyle strategies to reduce cardiovascular disease risk. These documents will serve as a public resource for advancing education, prevention, and treatment, and will also reveal current gaps in the knowledge and serve as guidance for future research investments.

As we adapt to changing times and refine the focus of our health education efforts, we remain committed to fulfilling our mission by facilitating the generation of rigorous systematic evidence reviews in support of the highest quality clinical practice guidelines worthy of the public trust. This new collaborative partnership model of guideline development will enable the NHLBI to continue to serve its unique leadership role—supporting essential research and acting as a trusted source of health information that educates patients and informs clinical practice.

An essay on "Refocusing the Agenda on Cardiovascular Guidelines: An Announcement from the National Heart, Lung, and Blood Institute" has been published in Circulation and the Journal of the American College of Cardiology.

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