The 2012 Joint European CVD Prevention Guidelines , that will be published at the EuroPRevent 2012 later this year, will be more concise, compact and supported by fewer references, according to Professor Joep Perk, Chairperson of the Task Force of the fifth edition, who states that the aim is to provide guidelines that contain recommendations, which can be readily applied and that show unequivocal evidence, saying:

“If we had picked up where we left off with the fourth edition guidelines, we’d have ended up with a 150-page document and 2000 references. And with that we’d have reached a dead-end.”

The rethink occurred after a benchmarking study assessed the penetration and application of the Joint Societies’ fourth Guidelines on CVD Prevention, concluding that, “substantial progress has been made” in implementing the guidelines, however, that many countries “have struggled with the task”.

The summary of the study was based on interviews held with representatives from each of the 13 country’s national organizations active in CVD prevention, to indicate “the enablers” and the hurdles that need to be overcome to fully implement the guidelines. The 13 countries representatives were from Estonia, France, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Romania, Russia, Spain, Sweden, and the UK.

Perk explains:

“Implementation is a key step in the development of all clinical guidelines. Without dissemination, guidelines will remain ineffective and of little more than academic interest. We wanted our next guidelines to really have an impact, and we were very sensitive to the difficulties many countries have clearly had in applying previous recommendations.”

Developed by a joint Task Force of the ESC and eight other European societies, the fifth European Guidelines on CVD Prevention is due to be published in May.

Dr. Karen Morgan from the Royal College of Surgeons in Dublin, Ireland, who is one of the benchmarking investigators supports the view that the value of the next European guidelines will depend on how their recommendations are transferred into daily practice, however, she recognized that the disease prevention progress of the fourth version of the guidelines has been different throughout Europe, stating:

“So the challenge for the next edition is to provide guidelines which are sufficiently detailed but still short and easily accessible in a number of languages and formats, so as to engage health professionals in their implementation.”

According to the fourth guidelines, benchmarking interviews and an evaluation revealed that ten of the 13 countries had implemented some of the guidelines that investigators defined into three categories:

  • Adoption as national guidelines with local adaptation, mainly the adjustment of risk charts to national data (Italy, Poland, Romania, Russia, and Spain)

  • Incorporation into national guidelines along with guidelines from other sources (Estonia, Germany, and the Netherlands)
  • Co-existence with national guidelines developed by the health authorities (France and Sweden)

Whilst Ireland applied the Joint CVD Prevention Guidelines ,together with guidelines from other sources, Norway and the UK applied completely different guidelines. Even though the health ministry granted their support for the joint guidelines in all countries, except for Ireland and Norway, and the basis for implementing the guidelines appeared to be secure, support from the active health authority did not always seem apparent.

For instance, interviewees reported various factors that stopped governments from pursuing their prevention initiatives more actively. These factors included the inability to commit funding in support of prevention activities, ideological beliefs in personal responsibility for lifestyle, an implied need to maintain tax revenues on alcohol and tobacco, as well as commercial interests of tobacco, agriculture, and food industries in local economies.

In addition, there were also other hurdles that needed to be overcome in everyday life, for instance, physicians having to face managing acute and chronic disease, “undervalued prevention” on a daily basis. Several interviewees also stated the guidelines themselves were just too detailed to be observed on a daily basis with over 100 pages in the full version, and that the risk structure under the SCORE system still needs to be more country-specific.

As a result of the benchmarking study, which the Task Force has been aware of throughout its duration, the new guidelines include several recommendations for better implementation that have been made by investigators, such as a single-page quick-reference format and wider availability of the pocket version. The Task Force has also produced various questions for CME credits that have been derived from the new guidelines.

The fifth edition of the guidelines will be published in May in the European Heart Journal, when they will also be presented at the EuroPRevent 2012 congress in Dublin with a completely new look and feel of only 50 pages and 150 references. Perk says:

“We’ve taken the study’s comments to heart. Implementation is the key to the guidelines’ success, and that’s what we’re aiming for.”

The overall attitude, with regard to the benchmark study, was positive towards the concept of uniform prevention guidelines across Europe. The need for preventative measures, at both clinical and population levels, were readily acknowledged, and as already mentioned previously, these guidelines have made a major impact. Interviewees commented on specific levels of their development, that they were “satisfied with their scope, credibility and evidence base”.

Written by Petra Rattue