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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

(ACCF)/American Heart Association (AHA) Task Force on Practice Guidelines (Task Force) has created a “focused update” process to revise the existing guideline recommendations that are affected by 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 focused updates are prompted following a thorough review of late-breaking clinical trials presented at national and international meetings, in addition to other new published data deemed to have an impact on patient care (Section 1.1, “Methodology and Evidence Review”). Through a broadbased vetting process, the studies included are identified as being important to the relevant patient population. The focused update is not intended to be based on a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that may affect changes to current recommendations.

Specific criteria or 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 industry relationships or other potential bias;

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