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Has guideline development gone astray? No

BMJ 2010; 340 doi: (Published 29 January 2010) Cite this as: BMJ 2010;340:c343
  1. Raymond J Gibbons, Arthur M and Gladys D Gray professor of medicine1,
  2. Elliott M Antman, professor of medicine2,
  3. Sidney C Smith, professor of medicine 3
  1. 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester MN 55905, USA
  2. 2Cardiovascular Division, Brigham and Women’s Hospital, Boston MA 02115, USA
  3. 3Division of Cardiology, University of North Carolina, Chapel Hill NC, USA
  1. Correspondence to: R J Gibbons gibbons.raymond{at}

    The move to evidence based medicine has led to a proliferation of guidelines. R Grol (doi: 10.1136/bmj.c343) is concerned that many are of poor quality, but Raymond Gibbons and colleagues argue that guidelines are important for improving health

    Guideline development in cardiovascular diseases is a well developed process in both the United States and Europe that has enhanced the delivery of proved treatments and improved patient outcomes. It most certainly has not gone astray.

    Guidelines for cardiovascular disease

    Between 1970 and 2000, life expectancy in the United States increased by six years,1 with nearly two thirds of that increase, 3.9 years, due to improved outcomes in cardiovascular diseases and stroke. Half of the improvement in coronary heart disease mortality was due to improvement in population risk factors; the other half could be attributed to improved evidence based treatment.2

    Unfortunately, proved treatment strategies were not consistently applied. Permanent pacemakers were definitely justified in less than half of patients who received one and not justified about 20% of the time.3 Less than half of patients presenting with acute myocardial infarction who had had a previous event and no contraindications were taking aspirin. …

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