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This year, four new European Society of Cardiology (ESC) Guidelines will be published—covering acute myocardial infarction/ST-segment elevation myocardial infarction (AMI/STEMI), valvular heart disease, peripheral arterial disease, and dual antiplatelet therapy. As with previous editions, the document on valvular heart disease has been developed as a joint guideline with the European Association For Cardio-Thoracic Surgery (EACTS), the document on peripheral arterial disease has been developed in collaboration with the European Society for Vascular Surgery (ESVS) and the focused update on dual antiplatelet therapy developed in collaboration with EACTS. Each represents at least two years’ worth of extensive task force work including literature reviews, synthesis of new evidence, and consensus to provide the latest information for clinicians to use in their everyday clinical practice.
Professor Stephan Windecker (Bern University Hospital, Bern, Switzerland), acting chair of the ESC Committee for Practice Guidelines (CPG) 2016–2018 and Chairperson of tomorrow’s 2017 ESC Guideline Overview session with Professor Jean-Philippe Collet (Université Pierre et Marie Curie [UPMC-Paris 06], Institut de Cardiologie, Pitié-Salpêtrière Hospital [AP-HP], ACTION Group, Paris, France), says that putting together an ESC Guideline is such a long and comprehensive process that the preparatory work to establish the task forces for the 2019 ESC Guidelines—a full two years before they will be published—“has already been done”.
He explains that when Guidelines on a specific topic need to b e revised, usually every four to six years, a Task Force consisting of 20 to 30 experts and “typically two to three chairs” will be created. This Task Force comes up with a “table of contents” that covers every aspect of the topic that needs to be included in the new Guideline, encompassing prevention, diagnosis, risk assessment, therapy, review of indications, management strategies and performance measures. They then review the new data in the respective field and analyse that data to develop a consensus for the recommendations of the new Guidelines. Subsequently, an independent panel of reviewers—ranging from “global” reviewers who look at all of the recommendations to specialists (focused reviewers) who look at specific areas—evaluates the resultant Guideline document. Prof. Windecker comments that, ESC Guidelines, because of the extensive work and careful review that goes into them, represent high-quality documents that guide clinical practice in many geographies beyond Europe.
However, while the process of developing ESC Guidelines is long and thorough, the task forces make every attempt to draft the Guidelines as concisely as possible. The ESC CPG has taken steps to ensure that the Guidelines remain readable. “We have noticed that over the past decade, cardiology has witnessed a rapid evolution of diagnostic and therapeutic modalities together with an exponential increase of publications. Inevitably ESC Guidelines have become more extensive, challenging their translations into clinical practice. Thus, we implemented a strict word count and, in each Guideline, we have put a colour-coded table that clearly shows what the new recommendations are and how they compare to previous versions.” Other items include a list of the “gaps in evidence” to increase awareness of areas that need further research and, hopefully, stimulate research in those areas. Additionally, key messages summarise the most important aspects of a given Guideline and assist the EURObservational Research Programme to assess how well ESC Guideline recommendations are being put into practice across Europe. At tomorrow’s session, the four ESC Guidelines 2017 that will be presented
At tomorrow’s session, the four ESC Guidelines 2017 that will be presented are: AMI/STEMI; Diagnosis and treatment of peripheral arterial diseases; Focused update on dual antiplatelet therapy ; and valvular heart disease. Prof. Windecker believes that the session is valuable for all delegates—regardless of their medical specialty—as they cover a broad range of cardiovascular disease and will be useful for a practising cardiologist. Furthermore, he says that both attending the session and reading the guideline documents (www.escardio.org/Guidelines/Clinical-Practice- Guidelines) is worthwhile. “The session will give an impression of what is to be found in the new Guidelines and what is new compared with previous Guidelines. It will provide a succinct summary of what the key messages are,” Prof. Windecker comments.
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