This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letters  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Education  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Quality of Care, Other  • Statistics and Research Methods  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Dr Norris raises concerns about the process of guideline writing and development by the ACC/AHA. Our study focused on understanding the evolution of classes of recommendation to their present state and, more importantly, the extent to which the various levels of evidence were present within each class of recommendation. In our review, we found nothing to suggest that the ACC/AHA evaluation of evidence results in an inaccurate assessment of the existing evidence base, although this was not a primary objective of our study and was not systematically reviewed. We judged the language used for classes of recommendation and levels of evidence to be appropriate. Given the evolution of changes in the classes of recommendation and levels of evidence ratings of the ACC/AHA, it is our conclusion that the need for recommendations is increasing at a rate much greater than the available evidence base. This situation must be addressed . . . [Full Text of this Article]

Pierluigi Tricoci, MD, MHS, PhD
trico001@dcri.duke.edu

Robert M. Califf, MD
Division of Cardiology
Duke Translational Research Institute
Durham, North Carolina

Sidney C. Smith Jr, MD
Center for Cardiovascular Science and Medicine
University of North Carolina
Chapel Hill

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Association Between Hospital Process Performance and Outcomes Among Patients With Acute Coronary Syndromes
Eric D. Peterson, Matthew T. Roe, Jyotsna Mulgund, Elizabeth R. DeLong, Barbara L. Lytle, Ralph G. Brindis, Sidney C. Smith, Jr, Charles V. Pollack, Jr, L. Kristin Newby, Robert A. Harrington, W. Brian Gibler, and E. Magnus Ohman
JAMA. 2006;295(16):1912-1920.
ABSTRACT | FULL TEXT  

RELATED LETTERS

Clinical Practice Guidelines and Scientific Evidence
Susan L. Norris
JAMA. 2009;302(2):142.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Finlay A. McAlister
JAMA. 2009;302(2):142-143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Francesco Enia
JAMA. 2009;302(2):143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Christian M. Pettker and Edmund F. Funai
JAMA. 2009;302(2):143.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Elliott M. Antman and Raymond J. Gibbons
JAMA. 2009;302(2):143-144.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Mark D. Huffman and Robert O. Bonow
JAMA. 2009;302(2):144-145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
John Concato and Ralph I. Horwitz
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Robert S. Bobrow
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence
Shyam S. Kothari
JAMA. 2009;302(2):145.
EXTRACT | FULL TEXT  

Clinical Practice Guidelines and Scientific Evidence—Reply
Terrence M. Shaneyfelt and Robert M. Centor
JAMA. 2009;302(2):146-147.
EXTRACT | FULL TEXT