Overview, Approach, and Background for Cardiovascular Risk Reduction Clinical Practice Guidelines
- Guidelines Development Approach
The National Heart, Lung, and Blood Institute is leading the development of cardiovascular risk reduction guidelines for adults using state-of-the-art methodology. Guidelines on cholesterol, hypertension, and obesity in adults are currently in development.
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Guidelines Development Approach
The NHLBI convened three expert panels to update the existing guidelines on high blood cholesterol, high blood pressure, and obesity. In addition, three work groups were convened to examine cross-cutting issues: lifestyle interventions, risk assessment, and guidelines implementation.
The Panels and Work Groups are using state-of-the-art principles of evidence-based medicine and innovative electronic tools to identify, review, and evaluate the scientific evidence. The process starts with evidence models and a set of prioritized critical questions identified as important for clinical practice. The critical questions are answered by conducting systematic reviews of the scientific evidence using a rigorous and standardized approach for searching and evaluating the literature.
The process from identification of questions to drafting reports includes several steps: formulating critical questions and study eligibility; identifying, retrieving, reviewing, and rating the quality of the relevant studies; developing evidence tables that summarize key information from the studies; summarizing and rating the body of evidence for each critical question; and determining and grading evidence-based clinical practice recommendations.
The ultimate goal of this major effort is to translate scientific evidence into clinical practice to reduce disease burden and improve health outcomes for cardiovascular diseases - the leading causes of death in the United States.
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The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership through research and education to enhance the health of all individuals so that they can live longer and more fulfilling lives. To enact this vision, in 2007 the NHLBI released a strategic plan, "Shaping the Future of Research." The plan contains three goals: Goal 1 is to increase understanding of the molecular and physiological basis of health and diseases; Goal 2 is to improve understanding of the clinical mechanisms of disease and thereby enable better prevention, diagnosis, and treatment; and Goal 3 is to translate research into practice for the benefit of personal and public health. Development, dissemination, and implementation of clinical practice guidelines are key components of Goal 3.
The NHLBI has a long history of developing clinical practice guidelines, particularly those addressing cardiovascular risk factors. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure released the first JNC report in 1976, followed by several additional JNC reports, with the most recent JNC 7 released in 2003. The Adult Treatment Panel (ATP) released clinical guidelines on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults in 1988, followed by ATP II and III, with an update in 2004. The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults were released in 1998. These guidelines have been extremely successful in calling attention to, and improving care for, the cardiovascular risk factors of hypertension, high blood cholesterol, and obesity.
The NHLBI has now embarked upon a new vision for the cardiovascular disease prevention guidelines - taking them to the next level by using an integrative approach and employing new state-of-the-art evidence-based methods. This vision emanated from recommendations by experts, practitioners, and stakeholders.
In 2005, NHLBI convened a "Cardiovascular Disease Thought Leaders Meeting" to seek input for developing the next generation of clinical guidelines on cardiovascular risk. Recommendations included maintaining risk-factor-specific clinical guidelines as well as establishing a process to integrate the science and clinical recommendations for cardiovascular risk reduction. In 2006, NHLBI convened a meeting of "Clinical Guidelines Users and Developers". Recommendations included creating an integrated guideline that would address real-world clinical issues, attend to various approaches for risk assessment, include unified lifestyle recommendations, and focus on implementation aspects for clinical practice. In 2007, NHLBI convened a "Clinical Guidelines Leadership Group Meeting" to obtain more specific input on process and approach from both public and private sectors, including representatives from key stakeholder organizations, researchers, and practitioners.
The result of all these deliberations is the current major effort at NHLBI in leading the development of a set of evidence-based, comprehensive clinical guidelines for cardiovascular risk reduction in adults. The guidelines will be principally aimed at primary care practitioners and their patients to assist adults in reducing their cardiovascular risk, but will also be valuable to cardiovascular specialists and their patients. The process also will identify areas where additional research is needed to obtain evidence that can inform practice.
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Last Updated October 2012