NHLBI gets out of the guideline business


The National Heart, Lung, and Blood Institute won’t be issuing stand-alone cardiovascular clinical guidelines anymore.

Officials at NHLBI, part of the National Institutes of Health, announced June 19 that they would instead focus on putting out the systematic evidence reviews that other organizations rely on when formulating their clinical guidelines. And in some cases, they will team up with those organizations to issue guidelines.

Dr. Pamela Douglas

The switch, which puts NHLBI in line with the rest of NIH, is not expected to delay the release of two highly anticipated clinical guidelines: JNC-8 and ATP-4, according to institute officials. They said those guidelines will be completed in collaboration with other groups and that they should be published within a matter of months. NHLBI will also release evidence reviews on these topics.

The NHLBI decision to move away from issuing its own stand-alone guidelines was due in large part to the changing landscape for guideline development.

In an article published in both Circulation and the Journal of the American College of Cardiology, NHLBI leaders said the number of available guidelines has "exploded," and that guideline developers are now faced with a series of questions about how to ensure that the many guidelines aren’t contradictory and which groups are best to lead guidelines development (Circulation 2019 June 19 [doi: 10.1161/circulationaha.113.004587]).

As a result, NHLBI will focus primarily on convening expert panels to generate systematic evidence reviews and working with partner organizations with frontline clinical experience.

"In this new collaborative partnership model, we want to engage professional societies that are directly involved in frontline clinical practice because they are capable and well suited to drive the effort of guideline development and implementation into evidenced-based clinical practice that enhances the public health," said Dr. Gary H. Gibbons, NHLBI director.

NHLBI plans to follow the best practice standards outlined by the Institute of Medicine in 2011 for generating systematic evidence reviews.

Dr. Doug Campos Outcalt, clinical sciences analyst for the American Academy of Family Physicians, said that if NHLBI is able to produce evidence reviews that meet the criteria for quality set out by the Institute of Medicine, it will be a valuable contribution. However, he emphasized the importance of coordinating with the Agency for Healthcare Research and Quality to avoid duplication of evidence reports and make information available on a wider variety of topics.

The move was praised by the American College of Cardiology. Dr. Pamela Douglas, ACC past president and professor of cardiology at Duke University, Durham, N.C., said that guideline development has grown more different for all organizations involved as the amount of evidence increased and the process has become a science all its own. With the NIH focus on evidence review and the guideline process falling mainly to clinical groups like the ACC, it lets each set of organizations "play to their strengths and it creates a more rigorous evidence synthesis," Dr. Douglas said.

On Twitter @MaryEllenNY

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