The Need for Evidence to Guide Clinical Practice: How Should Medicine Translate Knowledge to Practioners

The medical literature is expanding at a phenomenal rate. Between the decade of 1997 and 2007, there were >164 000 cardiology articles (a 57% increase) published in >220 journals (a 75% increase) during that decade. With this continued growth in articles and journals, supplemented by the social media force of Twitter, it is impossible to imagine how a practicing cardiologist can possibly stay abreast of evolving medical knowledge. To meet this need, the American College of Cardiology (ACC) and the American Heart Association (AHA) have been collaborating for almost 35 years to synthesize the literature into clinical practice guidelines. To date, there have been ≈600 guidelines and statements to help support clinical practice. Moreover, the ACC and AHA have invested in numerous efforts, given the importance of guidelines and recent concerns raised by the National Academy of Medicine, to further refine and improve the methodological rigor of these reports. These have included greater use of systematic reviews, greater inclusion of patients and nonspecialists, collaboration with other specialty societies, and ongoing updating of guidelines, which are all congruent with current recommendations. Despite these Herculean efforts, in this issue of Circulation: Cardiovascular Quality and Outcomes, Dr Ioannidis argues that professional societies should no longer lead the development of clinical practice guidelines. From our perspective, this viewpoint stems from several erroneous assertions.