Updating guidelines

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All guideline recommendations require a confidential vote by the writing group and must be approved by a consensus of the members voting.Members who recused themselves from voting are noted on the title page of this document.Clinical decision making should consider the quality and availability of expertise in the area where care is provided.These guidelines may be used as the basis for regulatory or payer decisions, but the ultimate goals are quality of care and serving the patient’s best interests.Of note, the implications of older studies that have informed recommendations but have not been repeated in contemporary settings are considered carefully. Applying Classification of Recommendations and Level of Evidence*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use.

Writing group members who did not participate are not listed as authors of this focused update.Now, however, new evidence will be reviewed in an ongoing fashion to more efficiently respond to important science and treatment trends that could have a major impact on patient outcomes and quality of care.Evidence will be reviewed at least twice a year, and updates will be initiated on an as-needed basis as quickly as possible, while maintaining the rigorous methodology that the ACCF and AHA have developed during their 25 years of partnership.Specific criteria/considerations for inclusion of new data include the following: In analyzing the data and developing updated recommendations and supporting text, the focused update writing group used evidence-based methodologies developed by the ACCF/AHA Task Force on Practice Guidelines, which are described elsewhere.The schema for classification of recommendations and level of evidence is summarized in Table 1, which also illustrates how the grading system provides an estimate of the size of the treatment effect and an estimate of the certainty of the treatment effect.Although randomized trials may not be available, there may be a very clear clinical consensus that a particular test or therapy is useful and effective.

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