Management of valvular heart disease - Guidelines ESC 2012

Guidelines summarize and evaluate all evidence available, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines are not substitutes for-, but complements to, textbooks and cover the ESC Core Curriculum topics. Guidelines and recommendations should help physicians to make decisions in their daily practice.

However, the final decisions concerning an individual patient must be made by the responsible physician(s). A great number of guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of their impact on clinical practice, quality criteria for the development of guidelines have been established, in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC web site (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC and European Association for Cardio-Thoracic Surgery (EACTS) to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management and/or prevention of a given condition, according to ESC Committee for Practice Guidelines (CPG) and EACTS policy.

A critical evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The levels of evidence and the strengths
of recommendation of particular treatment options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2.

The experts of the writing and reviewing panels filled in Declarations of Interest forms dealing with activities which might be perceived as real or potential sources of conflicts of interest. These forms were compiled into one file and can be found on the ESC web site (http://www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period must be notified to the ESC and EACTS and updated. The Task Force received its entire financial support from the ESC and EACTS, without any involvement from the healthcare industry.

The ESC CPG, in collaboration with the Clinical Guidelines Committee of EACTS, supervises and co-ordinates the preparation of these new Guidelines. The Committees are also responsible for the endorsement process of these Guidelines. The ESC/EACTS Guidelines undergo extensive review by the CPG, the Clinical Guidelines Committee of EACTS and external experts. After appropriate revisions, it is approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal and the European Journal of Cardio-Thoracic Surgery.

After publication, dissemination of the message is of paramount importance. Pocket-sized versions and personal digital assistant (PDA) downloadable versions are useful at the point of care.

Some surveys have shown that the intended end-users are sometimes unaware of the existence of guidelines, or simply do not translate them into practice, so this is why implementation programmes for new guidelines form an important component of the dissemination of knowledge. Meetings are organized by the ESC and EACTS and directed towards their member National Societies and key opinion-leaders in Europe. Implementation meetings can also be undertaken at national levels, once the guidelines have been endorsed by the ESC and EACTS member societies and translated into the national language. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.

Thus the task of writing these Guidelines covers not only the integration of the most recent research, but also the creation of educational tools and implementation programmes for the recommendations.

The loop between clinical research, writing of guidelines and implementing them into clinical practice can only then be completed if surveys and registries are performed to verify that real-life daily practice is in keeping with what is recommended in the guidelines.

Such surveys and registries also make it possible to evaluate the impact of implementation of the guidelines on patient outcomes. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the  circumstances of the individual patient, in consultation with that patient and—where appropriate and necessary—the patient’s guardian or carer. It is also the health professional’s responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

© The European Society of Cardiology and the European Respiratory Society 2012. All rights reserved.