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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 . . . [Full Text of this Article]

Mark D. Huffman, MD, MPH
m-huffman@md.northwestern.edu

Robert O. Bonow, MD
Department of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois

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