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Implementation of Guidelines on Atrial Fibrillation Management in the Global Arena: So Many Actors on Stage!

Published:April 07, 2021DOI:https://doi.org/10.1016/j.ejim.2021.03.013
      According to the seminal definition by the Institute of Medicine released in 1990, clinical guidelines represent “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” [
      ] During the last two decades, clinical guidelines have evolved into an irreplaceable instrument for a wide population of key stakeholders, including physicians, patients, hospitals, educational bodies, manufacturers, health providers and insurers. At present, guidelines and recommendations provide substantial help to health professionals in taking decisions on a daily basis. An optimal benefit is accomplished when application of guidelines’ recommendations results in improvement of clinical outcomes. In addition, guidelines’ recommendations are meant for ameliorating consistency of care, thereby reducing disparities in, and increasing efficiency of diagnostic paths and therapeutic strategies delivered in patients experiencing similar conditions. The value of guidelines notwithstanding, it is recognized that any final decisions concerning an individual patient should be made by the responsible health professional in consultation with the patient and caregiver as appropriate [
      • Kirchhoff P
      • Benussi S
      • Kotecha D
      • Ahlsson a
      • Atar D
      • Casadei B
      • et al.
      ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
      ]. This statement has a special significance, if one considers that: 1) many conditions experienced in daily practice do not comply precisely with those addressed in the guidelines; 2) high-quality studies driving guidelines recommendations do not cover all possible variations expressed in the individual patient.
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