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Keeping pace with the stream of new data and evolving evidence on which guideline recommendations are based is an ongoing challenge to timely development of clinical practice guidelines. In an effort to respond promptly to new evidence, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force on Practice Guidelines (Task Force) has created a “focused update” process to revise the existing guideline recommendations that are affected by the evolving data or opinion. New evidence is 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 is reviewed at least twice a year, and updates are initiated on an as-needed basis and completed as quickly as possible while maintaining the rigorous methodology that the ACCF and AHA have developed during their partnership of 20 years. These updated guideline recommendations reflect a consensus of expert opinion after a thorough review primarily of late-latebreaking clinical trials identified through a broad-based vetting process as being important to the relevant patient population, as well as other new data deemed to have an impact on patient care (see Section 1.1, Methodology and Evidence Review, for details). This focused update is not intended to represent an update based on a complete literature review from the date of the previous guideline publication. Specific criteria/considerations for inclusion of new data include the following:

publication in a peer-reviewed journal;

large, randomized, placebo-controlled trial(s);

nonrandomized data deemed important on the basis of results affecting current safety and efficacy assumptions, including observational studies and meta-analyses;

strength/weakness of research methodology and findings;

likelihood of additional studies influencing current findings;

impact on current and/or likelihood of need to develop new performance measure(s);

request(s) and requirement(s) for review and update from the practice community, key stakeholders, and other sources free of relationships with industry or other potential bias;

number of previous trials showing consistent results; and need for consistency with a new guideline or guideline updates or revisions.