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Individualizing Care in Patients With Associated Conditions and Comorbidities—The ACC and AHA recognize the complexity of managing patients with multiple conditions, compared with managing patients with a single disease, and the challenge is compounded when CPGs for evaluation or treatment of several coexisting illnesses are discordant or interacting (7).
The focus is on medical practice in the United States, but CPGs developed in collaboration with other organizations may have a broader target.The recommendations in this CPG are the official policy of the ACC and AHA until they are superseded by a published addendum, focused update, or revised full-text CPG.The recommendations listed in this CPG are, whenever possible, evidence based.In analyzing the data and developing CPGs, the GWC uses evidence-based methodologies developed by the Task Force (6).A key component of the ACC/AHA CPG methodology is the development of recommendations on the basis of all available evidence.Recommendations on value in proportion to resource utilization will be incorporated as high-quality comparative-effectiveness data become available (5).
The relationships between CPGs and data standards, appropriate use criteria, and performance measures are addressed elsewhere (4).
Management of RWI involves selecting a balanced GWC and requires that both the chair and a majority of GWC members have no relevant RWI (see Appendix 1 for the definition of relevance).
GWC members are restricted with regard to writing or voting on sections to which their RWI apply.
Recommendations are limited to treatments, drugs, and devices approved for clinical use in the United States.
Class of Recommendation and Level of Evidence—Once recommendations are written, the Class of Recommendation (COR; i.e., the strength the GWC assigns to the recommendation, which encompasses the anticipated magnitude and judged certainty of benefit in proportion to risk) is assigned by the GWC.
The Task Force makes every effort to avoid actual, potential, or perceived conflicts of interest that might arise through relationships with industry or other entities (RWI).