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Practical considerations, including time and resource constraints, limit the ERCs to addressing key clinical questions for which the evidence relevant to the guideline topic lends itself to systematic review and analysis when the systematic review could impact the sense or strength of related recommendations.
The GWC develops recommendations on the basis of the systematic review and denotes them with superscripted “SR” (i.e., ) to emphasize support derived from formal systematic review.
Management of RWI involves selecting a balanced GWC and requires that both the chair and a majority of GWC members have no relevant RWI (see Appendix 1 for the definition of relevance).
GWC members are restricted with regard to writing or voting on sections to which their RWI apply.
In addition, for transparency, GWC members’ comprehensive disclosure information is available as an online supplement.
Comprehensive disclosure information for the Task Force is also available as an online supplement.
Concurrently, the Level of Evidence (LOE) rates the scientific evidence supporting the effect of the intervention on the basis of the type, quality, quantity, and consistency of data from clinical trials and other reports (Table 1) (4).
Relationships With Industry and Other Entities—The ACC and AHA exclusively sponsor the work of GWCs, without commercial support, and members volunteer their time for this activity.
A key component of the ACC/AHA CPG methodology is the development of recommendations on the basis of all available evidence.Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. To ensure that CPGs remain current, new data are reviewed biannually by the GWCs and the Task Force to determine if recommendations should be updated or modified.In general, a target cycle of 5 years is planned for full revision (1).Although CPGs may be used to inform regulatory or payer decisions, the intent is to improve quality of care and be aligned with the patient’s best interest.
Evidence Review—Guideline writing committee (GWC) members are charged with reviewing the literature; weighing the strength and quality of evidence for or against particular tests, treatments, or procedures; and estimating expected health outcomes when data exist.
The Task Force recognizes the need for objective, independent Evidence Review Committees (ERCs) to address key clinical questions posed in the PICOTS format (P = population; I = intervention; C = comparator; O = outcome; T = timing; S = setting).