Manual for ACC/AHA Guideline Writing Committees

Methodologies and Policies from the ACC/AHA Task Force on Practice Guidelines

Section II: Tools and Methods for Creating Guidelines

• Writing Committee Discussions and Consensus Development

The safeguards of a group process should be initiated so as to ensure that the consensus achieved by the guideline development experts would reflect the consensus of the larger group of experts on the topic around the world. - Heffner, 1998

Referring back to Figure 1, writing committee discussions and consensus development is ongoing at all stages of guideline development. Since ACC/AHA guidelines are team-written documents, coming to agreement on the scope, clinical objectives, evidence tables, text, recommendations, and visual summaries occurs throughout document development. Sub-section writers often come to consensus through phone calls or e-mail exchanges of information, while the entire writing committee comes to consensus during the face-to-face meetings.

In evidence-based documents such as clinical practice guidelines, consensus development is often most important around topics that have no literature base. Writing groups are faced with the challenge of addressing an important clinical question despite a lack of data. The ACC/AHA guideline development process allows for the incorporation of minority opinions within the document if consensus can not be reached.

Finalizing the Document
At the final stages of guideline development, writers should re-examine the original goals regarding the scope of the guideline, as identified in Step One. Any identified gaps should be filled or explained before the document is sent to peer review. The writing group will be asked to give formal approval of the document both before peer review and after peer review edits have been incorporated. Checklist 5 (see below) is provided as a tool to conduct an internal review of the guideline recommendations at both of these junctions.

Checklist 5. Reviewing Guideline Recommendations Are the recommendations within the stated purpose and scope of the guideline? Are all recommendations cited and referenced (either in the text or in the evidence table)? Are all recommendations assigned a Classification of Recommendation and a Level of Evidence? Are clinically important and feasible recommendations made? Are areas of uncertainty and exceptions to the rule clearly identified? Are evidence tables and appropriate text provided to support recommendations, where applicable? Are recommendations and key clinical points displayed visually, when possible? Are the recommendations consistent with other ACC/AHA guidelines and other documents on the same or related topics?