To the Editor: In their Editorial, Drs Shaneyfelt and Centor1 called for several key changes for developing guidelines, including transparency, centralization, prioritization, and flexibility. The authors concluded that “[u]nless there is evidence of appropriate changes in the guideline process, clinicians and policy makers must reject calls for adherence to guidelines.”
However, data from the CRUSADE2 and OPTIMIZE3 registries, which studied adherence to therapy based on ACC/AHA guidelines for acute coronary syndromes and acute heart failure, respectively, have demonstrated that increased adherence to clinical practice guidelines is associated with improved in-hospital and follow-up morbidity and mortality. These registries have enrolled more 113 000 patients at more than 600 US hospitals and have had a significant effect on validating the role of clinical practice guidelines in real-world settings. Beyond the US experience, countries such as China have also demonstrated improved outcomes associated with increased adherence to local guidelines.4 We view these domestic and global experiences as supportive of the overall guideline process.