Australian clinical guideline for diagnosing and managing acute coronary syndromes 2024

Development of recommendations

There are three classifications of guidance used throughout this guideline, in a hierarchy that reflects the strength of evidence and the context of their application: GRADE recommendations, consensus recommendations and practice points.

GRADE recommendations provide the most robust guidance, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology ^[3]. These recommendations balance benefits and harms, incorporate an individual’s preferences and consider resource use, offering either strong or weak recommendations depending on the certainty of evidence and the intervention's impact. GRADE definitions can be found in Table 1.

Consensus recommendations are used when the GRADE approach is not applicable, often due to indirect or limited evidence. These recommendations are informed by expert opinion, supported by available evidence, and consider values, preferences and resources. They provide critical guidance in areas where clinical decisions are necessary, even though the evidence base may not be direct or comprehensive.

Lastly, practice points offer actionable and practical advice to facilitate the implementation of recommendations. They detail the specifics of applying recommendations, such as who, what, how and when, and they often include supplementary information like medication dosing or tools to enhance implementation. While they do not stand alone, practice points are essential for ensuring that recommendations are effectively applied, particularly in settings with geographical or resource-related challenges.

Further information regarding the guideline update process, development of recommendations and conflicts of interest management can be found in Supplementary material A.