NHLBI shifts from guideline producer to OEM

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 - Time for Change

The National Heart, Lung, and Blood Institute (NHLBI) is stepping away from the role of producer of cardiovascular disease-related clinical practice guidelines to that of supplier. The institute announced June 19 in the Journal of the American College of Cardiology that it planned to provide reviews that others could use to create “guideline products.”    

NHLBI director Gary H. Gibbons, MD, and institute members wrote that the move was in response to changes in cardiovascular research, patient management and the dissemination of knowledge. They noted that the amount of evidence on topics such as cholesterol and blood pressure and accessibility to physicians and patients have grown over time.

Also, other institutes have limited their involvement with guidelines by collaborating with professional societies and other organizations. “In recent history, the NHLBI has been the lone exception to this general NIH [National Institutes of Health] practice.”   

In an effort to rein in the proliferation of guidelines and ensure quality, the Institute of Medicine issued one report that set standards for systematic reviews and a second report on the development of “trustworthy” guidelines. An advisory panel for the NHLBI considered that split in its evaluation of cardiovascular disease-related documents on cholesterol, blood pressure, risk assessment, lifestyle interventions and obesity. The result was a decision to shift NHLBI’s role to reviews.

“[W]e plan to refocus our health education agenda on our core mission of knowledge generation and synthesis by supporting and producing rigorous systematic reviews that can then be used by other collaborating organizations to generate guideline products that serve the public interest,” they wrote. “The NHLBI has decided that the five integrated cardiovascular guideline products will be published as evidentiary reviews, and that the Institute will subsequently collaborate with other organizations to prepare and issue the related clinical practice guidelines.”

Going forward, the institute said it will reach out externally to identify high-priority needs and frame research questions; integrate current standards and best practices into reviews; implement an internal evaluation process; and look for gaps in evidence to that can be addressed through research.