Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
The biblical story of the Tower of Babel (1), in which people could not coexist because of the different languages they spoke, provides a telling analogy for the state of contemporary clinical practice guideline development. The cardiology community and, more importantly, cardiovascular patients would reap tremendous benefit if there was a more unified approach to cross-continental development of clinical practice guidelines. The world continues to be “flattened” by heightened communication and interaction through technology, which should only serve to ease the process of unifying patient management recommendations across countries and continents.
Although I personally understand that it will be a huge feat to accomplish this goal, we have a precedent for a successful development and deployment of clinical guidelines with the 2001 ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation, which were developed with a committee of experts from the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC), and the North American Society of Pacing and Electrophysiology (2). While serving as the committee chair for these guidelines, I witnessed many of my colleagues put aside their personal and professional differences for the betterment of patients with atrial fibrillation. Collectively, we were always focused on the goal of having congruous recommendations on both sides of the proverbial pond. In stark contrast, we have seen the clinical confusion that has arisen from separate, often disparate recommendations between the United States and Europe.
With this awareness, I began to compile and edit The AHA Guidelines and Scientific Statements Handbook, issued in 2009 (3). My fellow authors and I recognized this clinical confusion and attempted to take initial steps to clarify these disparities for the practicing cardiologist. Through appropriate tables, this textbook demonstrated side-by-side comparisons of the ESC and ACC/AHA guidelines recommendations. I have personally showcased similar comparisons of ESC and ACC/AHA guidelines for fellows’ talks and grand rounds across the country to provide some clarity. However, the cardiovascular community cannot continue to be handicapped by such makeshift bandages for a bigger problem. Our societies need to come together to issue joint guidelines.
A recent ACC/AHA task force statement reinforced this idea (4). In looking to the past, the authors evaluated the 30-year journey of developing clinical practice guidelines, noting that they were “fueled by a shared sense of responsibility to translate available evidence into clinical practice to guide cardiovascular clinicians” (4). In looking toward the future, they noted the importance of harmonizing ACC/AHA clinical practice guidelines “with those issued by other organizations within the United States and abroad to maintain consistency and facilitate implementation” (4). This cross-continental coordination of guideline development and issuance is crucial for delivering superior cardiovascular care across the globe. Although there are distinct demographic, cultural, and socioeconomic considerations in patient management, we should not use this as a divisive reason not to harmonize our guidelines process; instead, we should explore those differences through open lines of communication and joint research efforts.
Indeed, dialogue between organizations is integral to moving in the appropriate direction for patients. This year, 2 versions of the perioperative cardiovascular evaluation and patient management clinical practice guidelines were issued, but they were created through collaborative efforts of the ACC, AHA, and ESC. In the accompanying editorial from the organizations (5), they explain that the revisions were begun independently; however, the leadership of the ACC/AHA and the ESC “recognized the importance of scientific collaboration and writing committee coordination for the benefit of the worldwide cardiology community.” Although the writing committees and task force groups worked and wrote independently on separate sides of the Atlantic Ocean, the revised recommendations were shared between the 2 writing committees, “so that the rationales for any differences in recommendations could be articulated clearly” (5). This is a step in the right direction, but we have miles to traverse until the clinicians and patients reap the success of these societies uniformly working together to produce clinical practice guidelines. The cardiovascular community needs to embrace the biblical city of Babel before the people were given different languages, wherein the “whole world had 1 language and common speech” (1), when recommending care strategies for all cardiovascular patients.
Finally, I do not want this call to action to be misconstrued as curtailing the creative process, because individual societies have a wonderful outlet to put forth new ideas through scientific statements. Within these working groups or scientific statements, ideas can be appropriately disseminated to reflect differing points of view. Within the Journal, we have started to issue such statements from councils at the College. Some concepts from these types of statements or clinical documents may ultimately make their way into clinical practice guidelines, which should stand alone as unified global recommendations for cardiovascular patient care.
- American College of Cardiology Foundation
- ↵Genesis 11:1–9 (NIV).
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