L’enorme aumento della quantità e della complessità dell’informazione scientifica
negli ultimi decenni è tale da rendere impossibile al medico prendere decisioni cliniche
basate sui dati più aggiornati e completi, a meno che operi in ambiti di patologia molto
limitati. Per ovviare a queste difficoltà sono stati sviluppati nuovi strumenti di informazione
e di aiuto alla pratica medica: tra questi le rassegne (overviews) di letteratura, le
analisi formali delle decisioni cliniche, le analisi economiche. Comune a questi strumenti
è il fatto che essi raccolgono e sintetizzano l’informazione in modo da facilitare
la decisione medica. Accanto a questi, sono state sviluppate le linee guida di pratica
clinica (Clinical Practice Guidelines) come uno strumento che ha un obiettivo più ambizioso:
quello di fornire al clinico non solo informazioni, ma anche raccomandazioni sul modo più
corretto di trattare i propri malati in particolari situazioni patologiche. Si tratta perciò di
uno strumento non meramente informativo, ma in certo modo di uno strumento normativo,
anche se – naturalmente – non vincolante per il clinico.
Ictus cerebrale: linee guida italiane di prevenzione e trattamento
Il gruppo di lavoro che ha sviluppato queste linee guida – la SPREAD Collaboration – rappresenta il modo
concreto per ottenere il requisito di multidisciplinarietà. La multidisciplinarietà è
stata ricercata coinvolgendo rappresentanti di tutte quelle professionalità e funzioni che, in diversi
momenti, possono essere coinvolte nell’applicazione – come soggetto attivo o passivo – delle linee guida.
Nella stesura di queste linee guida sono stati coinvolti alcuni referenti dell’utenza (associazioni di pazienti e familiari)
e, al fine di considerare gli aspetti multiprofessionali relativi al personale sanitario non medico, sono stati coinvolti
nel processo di revisione gruppi di infermieri, logopedisti e terapisti della riabilitazione.
Linee guida 2007 per il trattamento dell’ipertensione arteriosa
A cura del Comitato per la stesura delle Linee Guida della Società Europea
di Ipertensione Arteriosa (ESH) e della Società Europea di Cardiologia (ESC)
Tradotto da 2007 Guidelines for the management of arterial hypertension. The Task Force for the Management
of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). Eur Heart J 2007; 28: 1462-536.
Guidelines for the diagnosis and management of syncope (version 2009)
 Guidelines and Expert Consensus Documents summarize and
evaluate all currently available evidence on a particular issue with
the aim of assisting physicians in selecting the best management
strategies for a typical patient, suffering from 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 no substitutes for textbooks. The legal implications of
medical guidelines have been previously discussed.
The first ESC Guidelines for the management of syncope, were
published in 2001, and reviewed in 2004.1 In March 2008, the
CPG considered that there were enough new data to justify production
of new guidelines.
Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery
The present guidelines focus on the cardiological management of patients undergoing non-cardiac surgery, i.e. patients where
heart disease is a potential source of complications during surgery.
The risk of perioperative complications depends on the condition of
the patient prior to surgery, the prevalence of co-morbidities,
and the magnitude and duration of the surgical procedure.3
More specifically, cardiac complications can arise in patients with
documented or asymptomatic ischaemic heart disease (IHD), left
ventricular (LV) dysfunction, and valvular heart disease (VHD)
who undergo procedures that are associated with prolonged
haemodynamic and cardiac stress. In the case of perioperative
myocardial ischaemia, two mechanisms are important: (i) chronic
mismatch in the supply-to-demand ratio of blood flow response
to metabolic demand, which clinically resembles stable IHD due
to a flow limiting stenosis in coronary conduit arteries; and (ii) coronary
plaque rupture due to vascular inflammatory processes presenting
as acute coronary syndromes (ACSs). Hence, although LV
dysfunction may occur for various reasons in younger age groups,
perioperative cardiac mortality and morbidity are predominantly
an issue in the adult population undergoing major non-cardiac surgery.
ACC/AHA/NASPE Guideline for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices (version 2002)
ACC/AHA/NASPE 2002 Guideline Revision: Guiding Principles
- Changes reflect new clinical evidence, results from randomized clinical trials and clinical consensus.
- Healthcare, logistic, and financial implications of new evidence were considered in classifying indications.
- Made prior wording more precise when needed.
- Recommendations apply to ?most? patients, but the treating physician may modify based on an individual patient?s situation.
- Recommendations presume absence of inciting causes that may be eliminated without detriment to the patient.
- Efforts were made to maintain consistency with other related guidelines.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention
A Report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001
Guidelines for Percutaneous Coronary Intervention)
The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly engaged in
the production of such guidelines in the area of cardiovascular disease since 1980. This effort is directed by the
ACC/AHA Task Force on Practice Guidelines, whose charge is to develop and revise practice guidelines for important cardiovascular
diseases and procedures. The Task Force is pleased to have this guideline cosponsored by the Society for
Cardiovascular Angiography and Interventions (SCAI). Experts in the subject under consideration have been selected
from all three organizations to examine subject-specific data and write guidelines. The process includes additional
representatives from other medical practitioner and specialty groups where appropriate. Writing groups are specifically
charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or
procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities,
and issues of patient preference that might influence the choice of particular tests or therapies are considered, as
well as frequency of follow-up and cost-effectiveness. When available, information from studies on cost will be considered;
however, review of data on efficacy and clinical outcomes will be the primary basis for preparing recommendations in these guidelines.
Guidelines on the management of stable angina pectoris
The Task Force on the Managemt of Stable Angina Pectoris of the European Society of Cardiology
Stable angina pectoris is a common and disabling disorder. However, the managemt of stable angina has not been subjected
to the same scritiny by large randomized trials as has, for example, that of acute corinary symdromes (ACS) including
unstable angina and Myocardial infarction (MI). The optimal strategy of investigation and treatment is difficult
to define, and the developement of new tools for the diagnostic and prognostic assessment of patients, along with
the continually evolving evidence base for various treatment strategies, mandates that the existing guidelines be revised and updated.
Guidelines on Heart rate variability (HRV)
Standards of measurement, physiological interpretation, and clinical use.
Task Force of The European Society of Cardiology and The North American Society of Pacing
and Electrophysiology (Membership of the Task Force listed in the Appendix)
The last two decades have witnessed the recognition of a significant relationship between the autonomic nervous
system and cardiovascular mortality, including sudden cardiac death. Experimental evidence for an association
between a propensity for lethal arrhythmias and signs of either increased sympathetic or reduced vagal
activity has encouraged the development of quantitative markers of autonomic activity.
Heart rate variability (HRV) represents one of the most promising such markers. The apparently easy
derivation of this measure has popularized its use. As many commercial devices now provide automated
measurement of HRV, the cardiologist has been provided with a seemingly simple tool for both research and
clinical studies[5]. However, the significance and meaning of the many different measures of HRV are more
complex than generally appreciated and there is a potential for incorrect conclusions and for excessive or
unfounded extrapolations.
ACC/AHA 2007 STEMI Guidelines
Based on the 2007 Focused Update of the ACC/AHA Guidelines for the Management of Patients
With ST-Elevation Myocardial Infarction (STEMI): A Report of the ACC/AHA Task
Force on Practice Guidelines
The full-text guidelines and executive summary are also available on the Web sites: ACC (
www.acc.org
) and, AHA ( www.americanheart.org).
Transcatheter valve implantation for patients with aortic stenosis
Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European
Association of Cardio-Thoracic Surgery(EACTS) and the European Society of Cardiology (ESC), in collaboration
with the European Association of Percutaneous Cardiovascular Interventions(EAPCI).
Consensus Document on Cardiovascular Magnetic Resonance 2010
This document was developed by the American College of Cardiology Foundation (ACCF)
Task Force on Clinical Expert Consensus Documents (ECDs) and cosponsored by the
American Collegeof Radiology (ACR), American Heart Association (AHA), North
American Society for Cardiovascular Imaging (NASCI), and the Society for
Cardiovascular Magnetic Resonance (SCMR), to provide a perspective on the
current state of cardiovascular magnetic resonance (CMR). ECDs are intended
to inform practitioners and other interested parties of the opinion of
the ACCF and document cosponsors concerning evolving areas of clinical
practice and/or technologies that are widely available or new to the
practice community. Topics are chosen for coverage be cause the evidence
base, the experience with technology, and/or theclinical practice are
not considered suf?ciently well developed to be evaluated by the formal
ACCF/AHA practice guidelines process. Often the topicis the subject
of ongoing investigation.
Consensus Document on Coronary Computed Tomographic Angiography 2010
This document was reviewed by 15 official representatives from the ACCF
(2 representatives ), ACR (2 representatives), AHA (2 representatives ),
ASNC (1 representative ) NASCI (2 representatives ), SAIP ( 2 representatives ),
SCAI (2 representatives ), and SCCT (2 representatives), as well as 10 content reviewers,
resulting in 518 peer review comments. Peer review comments were entered into a table
and reviewed in detail by the writing committee chair. The chair engaged writing
committee members to respond to the comments, and the document was revised to
incorporate reviewer comments where deemed appropriate by the writing committee.
In addition, a member of the ACCF Task Force on Clinical ECDs served as lead
reviewer for this document. This person conducted an independent review of the
document at the time of peer review. Once the writing committee document
edits response to reviewer comments and updated the manuscript, the
lead reviewer assessed whether all peer review issues were handled
adequately or whether there were gaps that required additional
review The lead reviewer reported to the task force chair that
all comments were handled appropriately and recommended that
the document go forward to the task force for ?nal review and sign-off.
Guidelines for Mitral-Valve Operation; American College of Cardiology–American Heart Association 2006
ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:
a report of the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management
of Patients With Valvular Heart Disease): developed in collaboration with the Society of
Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography
and Interventions and the Society of Thoracic Surgeons. Circulation 2006;114(5):e84-e231.
[Erratum, Circulation 2007;115(5):e409.]
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