DEVELOPMENT OF THE AHCPR-SPONSORED HEART-FAILURE GUIDELINE - METHODOLOGIC AND PROCEDURAL ISSUES

Background: RAND, a nonprofit research and policy organization, served as contractor for the Agency for Health Care Policy and Research (AHC PR)-sponsored guideline on the management of patients with heart failu re due to left-ventricular systolic dysfunction. Panel: At meetings of the 16-member panel, discussions concerning practice recommendations were held until a consensus was reached. A draft algorithm was the key tool, serving as a starting point for panel discussion. The algorithm was revised after almost every panel meeting. Key Methods and Procedu ral Issues: Early decisions included how best to (1) focus the guideli ne and literature review, (2) rate the strength of evidence underlying practice recommendations, and (3) determine the relationship between strength of evidence and strength of recommendation. In the absence of data, or when panelists did not share a common opinion, the panel att empted to achieve a consensus. An example of this process-when and how patients should be evaluated for possible coronary artery revasculari zation-is discussed at length. Unlike previous AHCPR guideline panels, this panel solicited opinions of national experts early and often dur ing guideline development. This process helped the panelists arrive at conclusions on certain controversial issues. Conclusions: The guideli ne development process was complex and painstaking. The panelists and project staff believe that frequent peer review helped produce a guide line that can be widely accepted across clinical and geographic lines.