How European Society of Cardiology guidelines are made.

Undoubtedly, one of the most popular scientific activities within the European Society of Cardiology (ESC) is clinical practice guidelines. The guidelines are intended as an aid in our decisions with patients. However, there are clinical situations that are not included in the guidelines, or others that are supported by expert consensus in the absence of robust scientific evidence based on robust clinical trials. We cannot expect that guidelines cover the entire spectrum of a disease, nor do we intend to clarify all points of each disease with the help of the guidelines. The continuous evolution of science makes necessary the constant updating of clinical practice guidelines. There are some questions that often come up: how the topics are selected, how the members of a task force are chosen, or even how the composition of the clinical practice guidelines is selected. The Committee on Clinical Practice Guidelines (CPG) is a diverse group of experts from the ESC. Its coordinator is chosen by the President of the ESC and usually stays in function for 2 or 4 years. There is no fixed number of elected members of this committee, they are chosen by mutual accord between the President of the ESC and the Coordinator of the Committee. The members are chosen based on the representation of the different scientific areas of our Society. Thus, the Associations have a representative of their subspecialty as well as most of the Working groups. The functions of the Committee are to decide which will be the topics to be addressed by the next guideline, its thorough review, the election of the Chairs of each task force, and the Review coordinators of each guideline. Any topic related to the guidelines is discussed during the meetings of the CPG. Currently, the CPG is debating the need for a code of conduct related to potential conflicts of interest that might affect the composition of the members who undertake work in future guidelines or the need for a systematic review of the evidence that will specifically review some controversial points within the guidelines. Once the theme of the guideline and the people who will coordinate the Task Force have been selected, the rest of the members are chosen. This is a very transparent process that impedes that Coordinatorshaveany influenceon the compositionof the group, and therefore, avoiding any bias during the process. Coordinators then select the Working group or associations that are directly related to the topic. Once selected, the presidents of these associations and WG nominate their representative. This practice impedes any bias in the composition of the Task Force. The reviewers of the document are selected in the same way. The review Coordinators are selected by the CPG and their identity is not known by the members of the working group who wrote the document. Once again, the presidents of the Associations or related working groups are requested to propose their representatives. CPG members are also selected as reviewers, existing global whole document reviewers and focus reviewers on some particular aspect of it. These reviewers do not know who took part in the writing group guaranteeing the fairness of the process. In summary, the selection of the members of the task force or reviewers represents the pertinent scientific specialties within the ESC related to the topic of each guideline. The process is blind and ensuring its independence, confidentiality, and impartiality. Since last year there is a last filter in the review. All ESC National Societies sent a reviewer to look carefully all indications Class I and Class III, giving the possibility for each ESC .National Society to give their input from the beginning. And what can we expect now? First, from 2015 the CPG members will not be listed on the front page of the document. We are currently in a pilot phasewherea systematic review of the evidence, external to the ESC,will bedone.Thiswill reviewspecificpointsof theguidelines. Not less important is the issue of potential conflicts of interest and that CPG is currently developing a proposal that will be submitted for consideration to the ESC board. Nowadays, the criteria which invalidate an expert to be part of any committee within the guidelines include the possession of shares in companies related to the subject, receiving royalties directly related to or working part time or full time for a medical company. Certainly, the development of guidelines is a process of enormous responsibility. The constant evolution of science and the Society increases the need for a permanent audited and evolving process. The clear aim of excellence and practicality is always present among those who engage with enthusiasm and seriousness a good part of their time to this worthy work.