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Guidelines for the diagnosis and treatment of pulmonary hypertension

Nazzareno Galiè, Marius M. Hoeper, Marc Humbert, Adam Torbicki, Jean-Luc Vachiery, Joan Albert Barbera, Maurice Beghetti, Paul Corris, Sean Gaine, J. Simon Gibbs, Miguel Angel Gomez-Sanchez, Guillaume Jondeau, Walter Klepetko, Christian Opitz, Andrew Peacock, Lewis Rubin, Michael Zellweger, Gerald Simonneau, Alec Vahanian, Angelo Auricchio, Jeroen Bax, Claudio Ceconi, Veronica Dean, Gerasimos Filippatos, Christian Funck-Brentano, Richard Hobbs, Peter Kearney, Theresa McDonagh, Keith McGregor, Bogdan A. Popescu, Zeljko Reiner, Udo Sechtem, Per Anton Sirnes, Michal Tendera, Panos Vardas, Petr Widimsky, Udo Sechtem, Nawwar Al Attar, Felicita Andreotti, Michael Aschermann, Riccardo Asteggiano, Ray Benza, Rolf Berger, Damien Bonnet, Marion Delcroix, Luke Howard, Anastasia N Kitsiou, Irene Lang, Aldo Maggioni, Jens Erik Nielsen-Kudsk, Myung Park, Pasquale Perrone-Filardi, Suzanna Price, Maria Teresa Subirana Domenech, Anton Vonk-Noordegraaf, Jose Luis Zamorano
DOI: http://dx.doi.org/10.1093/eurheartj/ehp297 2493-2537 First published online: 27 August 2009


Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines).

In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition.

Unpublished clinical trial results are not taken into account. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2.

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Table 1

Classes of recommendations

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Table 2

Levels of evidence

The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise …

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