ESC Clinical Practice Guidelines: Supporting clinical decision-making for 30 years
30 Aug 2024
ESC Guidelines - 30 years The European Society of Cardiology’s mission is to reduce the burden of cardiovascular disease. A cornerstone of that mission is the development of its Clinical Practice Guidelines to support decision-making and improve patient outcomes.
“ESC Guidelines are unique. They are the bedrock of our decision-making. They help us save lives,” says Silvia Priori, CPG Committee Chair 2002–2004.
To mark the 30-year anniversary of ESC Guidelines that are used by healthcare practitioners the world over to diagnose and treat patients with cardiovascular diseases, we take a look at what the ESC has achieved so far and what we are still working towards.
Why does the ESC publish guidelines?
Medical knowledge increases exponentially, making it impossible for individual clinicians not only to process what has been published, but to assess whether this new information should be applied to their clinical practice.
The ESC looks at all the latest relevant trials, research and other sources to create recommendations that reflect best practice. ESC Guidelines synthesise all this current thinking so that the cardiology community doesn’t have to.
“There’s so much information out there it’s impossible to follow everything. ESC Guidelines curate what we need to know and then guide us on how to use it,” says Colin Baigent, CPG Committee Chair 2020–2022.
ESC Guidelines are also important for its constituent bodies, the National Cardiac Societies, many of whom endorse, translate and disseminate the guidelines at a national level. These activities are overseen by the National Guideline Coordinators who are also actively involved in recommending experts from their country to be involved in the peer review process.
Why are ESC Guidelines unique?
ESC Guidelines enrich the perspective of the guidelines produced at a national level because they reflect expertise and experiences from multiple countries and cultures.
Each guideline takes more than two years to create, involves an average of 26 authors, and is reviewed by nearly 100 experts from some 50 different countries. They are a significant undertaking, the process of which is conducted within a strict framework of governance to uphold the independence and integrity of the recommendations that enables healthcare professionals to trust them to support their decision-making.
“Because the recommendations in ESC Guidelines are developed and reviewed by hundreds of experts from around the world it makes them an invaluable source of knowledge in everyday clinical practice,” says Stephan Windecker, CPG Committee Chair 2018–2020.
ESC Guidelines are also an effective advocacy tool for any country to demonstrate what is required to deliver optimal patient care. These independent, evidence-based and expert-led guidelines demonstrate to policy makers what treatments are required to save lives.
How do we protect the Guidelines’ integrity?
The names of the guideline task force chairs and review coordinators are public. However, to preserve the confidentiality of the guideline process, the task force members and reviewers are bound by a non-disclosure agreement until after the official publication of the guidelines.
The ESC also applies a strict declaration of interest (DOI) policy to ensure all ESC volunteers share information about their interests and to manage possible conflicts. For volunteers working on guidelines, the regulations in place include a cap of €10,000 per year on earnings from industry. This applies to both personal earnings for volunteers and those for their institutions, should these impact their personal income. All DOIs must also include volunteers’ spouses or partners relationships with the healthcare industry. Furthermore, guideline authors can be excluded from voting on recommendations if there is a perceived conflict of interest. Along with the rigorous peer review process, the DOI policy ensures that ESC Guidelines provide an unbiased interpretation of the evidence to guide best practice.
“Our guiding principle for developing clinical practice guidelines is that they must be evidence-based, independent and support clinical decision-making. There is always room for improvement of course and the ESC is constantly striving to strengthen its methodology and ensure quality. For example, DOI regulations that have been applicable to guidelines task force chairs and review coordinators since 2022, became applicable to all task force members and all reviewers for the 2024 Guidelines. It’s a process that we never stop challenging and advancing,” says Prof. Ulf Landmesser, Germany - CPG Chair 2024-2026.
What is the role of patients in ESC Guidelines?
Since 2021, the ESC Guidelines have been created with contributions from patients from the ESC’s Patient Forum, to ensure the recommendations consider the patient perspective and experience of the people they are designed to treat.
For guidelines to be successfully implemented, it's necessary not only for clinicians to adhere to them, but for the recommendations to consider the individual needs of a patient. For example, a recommended drug regime may be optimal to extend life expectancy but could have an impact on quality of life that is unacceptable to some patients, meaning they would not follow it.
“Building the patient perspective into ESC Guidelines is game-changing. They ensure we treat the person. Not just the disease,” says Eva Prescott, CPG Committee Chair 2022–2024.
Patient versions of the guidelines are also being developed, using language and terminology that patients and their families can understand and relate to.
What’s next for ESC Guidelines?
“Throughout 2024 we have been discussing barriers to implementing the guidelines and how to overcome these and this will remain a focus moving forward. In addition, we continue to evaluate and evolve the guidelines development process to ensure the documents and related resources are of the highest quality possible. Ultimately, the guidelines are here to support the cardiovascular community and our patients. This will never change,” concludes Professor Prescott.
Four new guidelines covering Atrial Fibrillation, Elevated Blood Pressure and Hypertension, Peripheral Arterial & Aortic Diseases and Chronic Coronary Syndromes were released on 30 August 2024. Access the guidelines.
Find more information on upcoming guidelines.
Read more information on ESC Guidelines policies and procedure.
