The ACC has released two complementary methodology reports for creating Expert Consensus Decision Pathways and organizing Heart House Roundtables. The reports were published July 23 in the Journal of the American College of Cardiology.

The Expert Consensus Decision Pathway report outlines the rationale behind the creation of pathways and explains how each is developed, from selecting and prioritizing topics to approving and disseminating a final document. Once topics are selected, work groups are created, content is developed, and then each pathway must be peer reviewed, in addition to undergoing organizational review and approval. Of note, Expert Consensus Decision Pathways are a crucial part of "solution sets," part of the College's strategic efforts to enhance "actionable knowledge" and "make clinical information easier to consume, share, integrate and update" as decision pathways include clinical content that can be translated into tools to further accelerate the use of ACC clinical policy.

According to James L. Januzzi Jr., MD, FACC, chair of the writing committee for the 2019 Methodology for Creating Expert Consensus Decision Pathways, "the ACC established Expert Consensus Decision Pathways as a format for addressing key questions facing members across a range of high-value clinical topics." The main goal: to help inform clinicians about areas where evidence may be new and evolving or where sufficient data may be more limited. "If Guidelines are the 'why' of treatment, the Expert Consensus Decision Pathways provide 'the how,'" he and the other authors note.

To date, Expert Consensus Decision Pathways have been developed for a number of cardiovascular disease states including lipid disorders, valvular heart disease, heart failure, tobacco cessation, cardiovascular risk reduction in diabetes, and more. Looking to the future, ACC's Science and Quality Committee is focused on finding ways to leverage these, as well as additional Expert Consensus Clinical Pathways with other solution set tools to maximize the translation from evidence to practice and optimize patient care and outcomes. Among the areas of focus: providing guidance for health system leadership on structural and process needs to optimize delivery of care; supporting various members cardiovascular team members with evidence-based tools for use at the point of care; integrating clinical guidance and decision support into electronic health record and information technology tools; and engaging patients in their cardiovascular care.

ACC's Heart House Roundtables are often the starting point for an Expert Consensus Decision Pathway and other solution set tools. A second methodology report outlines the evolution of these roundtables since their inception in 2013 and describes and offers guidance on how they are developed.

"In recent years, the ACC has increased the use of a roundtable format to address high-value topics among a broad group of multidisciplinary stakeholders," write Richard J. Kovacs, MD, FACC, and Pamela B. Morris, MD, FACC, co-chairs of the writing committee, et al. The roundtables explore the practical issues that clinicians and patients face every day and allow participants the opportunity to brainstorm possible solutions to address them. The methodology for design and conduct of the roundtables has been successful in closing gaps in clinical care, furthering ACC's mission of transforming cardiovascular care and improving heart health, and addressing the challenges of population health and precision medicine.

Like the Expert Consensus Decision Pathway report, the Heart House Roundtable report details everything from how topics are selected, agendas are set, and importantly how participants are chosen. It also outlines industry involvement and firewalls and how the outputs of roundtable discussions are disseminated and/or used.

Since 2013, roundtables have focused on a number of areas including anticoagulation, dyslipidemia, valvular heart disease, heart failure, cardio-oncology, cardiovascular disease in diabetic patients, and risk communication. "These meetings have been pivotal to the development of multiple types of outputs as well as fostering societal and organizational relationships," according to Kovacs, Morris, et al. Looking ahead, the authors note that Heart House Roundtables will continue as a trusted forum for fostering important, focused discussions on key areas of cardiovascular disease.

Keywords: Cardiovascular Diseases, Critical Pathways, Leadership, Tobacco Use Cessation, Risk Factors, Research Report, Patient Care, Dyslipidemias, Diabetes Mellitus, Electronic Health Records, Heart Valve Diseases, Lipids, Heart Failure, Methods

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