When these guidelines are used as the basis for regulatory or payer decisions, the goal should be improvement in quality of care.
Clinical decision making should involve consideration of the quality and availability of expertise in the area where care is provided. As a result, situations may arise in which deviations from these guidelines may be appropriate. The ultimate judgment about care of a particular patient must be made by the clinician and patient in light of all the circumstances presented by that patient. The guidelines attempt to define practices that meet the needs of most patients in most circumstances. The ACC/AHA practice guidelines are intended to assist clinicians in clinical decision making by describing a range of generally acceptable approaches to the diagnosis, management, and prevention of specific diseases or conditions. For issues with sparse available data, a survey of current practice among the clinician members of the writing committee is the basis for LOE C recommendations and no references are cited. When recommendations at LOE C are supported by historical clinical data, appropriate references (including clinical reviews) are cited if available. For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C. Studies are identified as observational, retrospective, prospective, or randomized, as appropriate. The schema for the COR and LOE is summarized in Table 1, which also provides suggested phrases for writing recommendations within each COR. The writing committee reviews and ranks evidence supporting each recommendation, with the weight of evidence ranked as LOE A, B, or C, according to specific definitions.
The Level of Evidence (LOE) is an estimate of the certainty or precision of the treatment effect. The Class of Recommendation (COR) is an estimate of the size of the treatment effect, with consideration given to risks versus benefits, as well as evidence and/or agreement that a given treatment or procedure is or is not useful/effective or in some situations may cause harm. Abbreviations and Acronyms: 2D ( 2-dimensional), 3D ( 3-dimensional), ACE ( angiotensin-converting enzyme), AF ( atrial fibrillation), ARB ( angiotensin-receptor blocker), aPTT ( activated partial thromboplastin time), AR ( aortic regurgitation), AS ( aortic stenosis), AVR ( aortic valve replacement), BP ( blood pressure), CABG ( coronary artery bypass graft), CAD ( coronary artery disease), CMR ( cardiac magnetic resonance), COR ( Class of Recommendation), CT ( computed tomography), ECG ( electrocardiogram), HF ( heart failure), HIV ( human immunodeficiency virus), IE ( infective endocarditis), INR ( international normalized ratio), LA ( left atrium), LMWH ( low-molecular-weight heparin), LOE ( Level of Evidence), LV ( left ventricular), LVEF ( left ventricular ejection fraction), LVESD ( left ventricular end-systolic dimension), MI ( myocardial infarction), MR ( mitral regurgitation), MS ( mitral stenosis), MVR ( mitral valve replacement), NYHA ( New York Heart Association), NVE ( native valve endocarditis), PR ( pulmonic regurgitation), PROM ( predicted risk of mortality), PVE ( prosthetic valve endocarditis), RCT ( randomized controlled trial), RV ( right ventricular), TAVR ( transcatheter aortic valve replacement), TR ( tricuspid regurgitation), TS ( tricuspid stenosis), TEE ( transesophageal echocardiography), TTE ( transthoracic echocardiography/echocardiogram), UFH ( unfractionated heparin), VHD ( valvular heart disease), VKA ( vitamin K antagonist)
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