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Letters |

Clinical Practice Guidelines and Scientific Evidence

Mark D. Huffman, MD, MPH; Robert O. Bonow, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.913.
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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.


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July 8, 2009
Susan L. Norris, MD, MPH, MS
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.908.
July 8, 2009
Finlay A. McAlister, MD, MSc
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.909.
July 8, 2009
Francesco Enia, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.910.
July 8, 2009
Christian M. Pettker, MD; Edmund F. Funai, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.911.
July 8, 2009
Elliott M. Antman, MD; Raymond J. Gibbons, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.912.
July 8, 2009
John Concato, MD, MS, MPH; Ralph I. Horwitz, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.914.
July 8, 2009
Robert S. Bobrow, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.915.
July 8, 2009
Shyam S. Kothari, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.916.
July 8, 2009
Pierluigi Tricoci, MD, MHS, PhD; Robert M. Califf, MD; Sidney C. Smith, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.917-a.
July 8, 2009
Terrence M. Shaneyfelt, MD, MPH; Robert M. Centor, MD
JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.918.
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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