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About Clinical Practice Guidelines


What is a Clinical Practice Guidelines?


"Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990). They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature.


The purpose of guidelines is to help clinicians and patients make appropriate decisions about health care. Guidelines attempt to do this by:

  • Describing a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions.

  • Defining practices that meet the needs of most patients in most circumstances.

The recommendations are not fixed protocols that must be followed. Responsible clinician's judgment on the management of patients remains paramount. Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient.

Intended Users

These guidelines are primarily for use by clinicians--physicians, nurses, and other health professionals in clinical practice. They are also useful to managed care organizations and other groups that define benefit plans for patients or handle health care resources.


The guidelines on this Web site are either:

  • Current
  • Out-of-date archives

Current guidelines are those that were developed, reviewed, or revised within the last five years.

The archives include guidelines that are out-of-date. They have either been supplanted by a new guideline or have not been reviewed in the last five years. These guidelines are clearly marked, "Archive for historical reference only."

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Who Writes and Reviews Clinical Guidelines?

Expert Panels

Expert panels are formed to write clinical practice guidelines for the National Heart, Lung, and Blood Institute. An expert panel is a committee of unpaid experts appointed by the NHLBI. The chair and members are chosen mainly for their scientific and clinical expertise.

External reviewers

The draft from the expert panel is reviewed first by experts and intended users selected by the NHLBI. This is a peer review by experts with qualifications similar to the member of the expert panel. The intended users review the draft for practicality, including clarity, formatting, and the usefulness of the recommendations in practice. The expert panel will consider the comments and recommendations from the peer reviewers and intended users and make changes agreed upon by the panel to the draft.

The next draft is posted on the NHLBI Web Site and a call is issued for public review and comment. Reviewers may:

  • Submit written comments on the NHLBI Web Site
  • Attend a public review forum conducted by the expert panel to make public comments on the draft.

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How are Conflicts of Interest Managed?

This section describes how the NHLBI manages conflicts of interest among the members of the writing and review groups:

  • Prospective members of the writing and review groups submit written Conflict of Interest/Disclosure Statements to an internal review panel considering their nomination and acceptance.

  • The internal review panel considers conflicts of interest as a factor in the selection of nominees for writing and review groups. Scientific and clinical expertise remains the paramount criteria for selection.

  • Members verbally disclose any potential conflicts of interest to each other during a general meeting.

  • A methodologist is hired to work with writing groups to provide objectivity in data analysis and ranking of evidence through the preparation of evidence tables and facilitating consensus.

  • Offer opportunities for public review and comments via the NHLBI Web Site and/or a scheduled public forum.

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