Current and future relevance of guidelines.

Over the past 20 years, practice guidelines have become an increasingly popular tool for synthesis of clinical information. Clinical practice guidelines are commonly defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The objectives of guidelines are to enhance appropriateness of practice, improve quality of cardiovascular care, lead to better patient outcomes, improve cost effectiveness, help authorities to decide on the approval of drugs and devices, and identify areas of research needed. Guidelines may also be used as quality measurement for health insurance. We know from the Euro Heart Survey that practice varies from country to country in Europe, providing a rationale for achieving a common standard of care for cardiovascular diseases. A profusion of guidelines has been issued in recent years by different organisations—the European Society of Cardiology (ESC), the American Heart Association, the American College of Cardiology, and other related societies. By means of links to websites of national societies, several hundred guidelines are available. 4 This profusion can put at stake the authority and validity of guidelines which can only be guaranteed if they have been developed by an unquestionable decision making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing guidelines which are quoted as the preamble or appendix in the final reports.