SIGN is a collaborative network of clinicians, other health care professionals, and patient organisations, funded by the Clinical Resource and Audit Group (CRAG) of the Scottish Executive Health Department. SIGN guidelines are developed by multidisciplinary groups using a standard methodology based on a systematic review of the evidence. Further details about SIGN and the guideline development methodology are contained in SIGN 50: A guideline developer's handbook.

8.1 The guideline development group

Dr Chris Isles (Chairman), Consultant Physician, Dumfries & Galloway Royal Infirmary
Ms Gillian Armstrong, Physiotherapist, Glasgow Royal Infirmary
Dr Alan Begg, General Practitioner, Montrose
Dr John Bowbeer, General Practitioner, Ayr (resigned from group 2000)
Dr Anthony Breslin, Consultant in Public Health, Forth Valley Health Board, Stirling
Ms Ailsa Brown, Health Economist, Greater Glasgow Health Board
Dr Neil Campbell, CRC Fellow, Department of General Practice, University of Aberdeen
Ms Francesca Chappell, Information Officer, SIGN
Dr John Gillies, General Practitioner, Selkirk
Dr Belinda Green, Consultant Cardiologist, Ninewells Hospital, Dundee
Mr Angus Gunn, Patient representative, Edinburgh
Ms Patricia Isoud, Cardiac Rehabilitation Sister, Western Infirmary, Glasgow
Dr Grace Lindsay, Lecturer, Nursing and Midwifery Studies, University of Glasgow
Dr Paul MacIntyre, Consultant Physician and Cardiologist, Royal Alexandra Hospital, Paisley
Dr Karen Smith, Clinical Research Fellow (cardiac nursing), Ninewells Hospital, Dundee
Ms Nicola Stuckey, Clinical Psychologist, Astley Ainslie Hospital, Edinburgh
Ms Morag Thow, Lecturer, Department of Physiotherapy, Glasgow Caledonian University
Dr Iain Todd, Consultant in Cardiovascular Rehabilitation, Astley Ainslie Hospital, Edinburgh
Ms Joanne Topalian, Programme Manager, SIGN

Dr Chris Baker, Medical Director, Dumfries & Galloway NHS Trust, provided advice on implementation and audit.

The membership of the guideline development group was confirmed following consultation with the member organisations of SIGN. Declarations of interests were made by all members of the guideline development group. Further details are available from the SIGN Executive.

8.2 Systematic literature review

The evidence base for this guideline was synthesised in accordance with SIGN methodology.

A number of systematic literature searches were carried out (full details of the search strategies used and the coverage of the Internet search are available from the SIGN Executive). Papers were only included if they adhered to recognisable methodological principles, including adequate sample size, a clearly identified hypothesis and measure of outcome, and accurate reporting of results.

An Internet search was carried out to identify existing guidelines and reviews on cardiac rehabilitation. This search used a range of general and specialised search engines, specific medical sites such as the National Guideline Clearinghouse (http://www.guideline.gov), and the following databases: Medline, Healthstar, Embase, PsychINFO, Cinahl, and the Cochrane Library. A search for economic literature was also performed in Medline, Healthstar, Embase, the Cochrane Library, and NEED. The search for systematic reviews and meta-analyses covered the period January 1991 to May 2000. The Cochrane review Exercise-based Rehabilitation for Coronary Heart Disease,⁹³ an AHCPR publication Cardiac Rehabilitation: Clinical Guideline No.17,¹⁴⁶ Effective Health Care: Cardiac Rehabilitation,¹⁴⁷ and systematic reviews by Oldridge et al (1988)¹³⁵ and Goble and Worcester (1999)⁹¹ provided much of the evidence for this guideline.

Additional searches were performed covering the period January 1995 to September 2000 to bring the literature up to date for randomised controlled trials and the evidence base was further updated during the course of development of the guideline.

8.3 Consultation and peer review

8.3.1 NATIONAL MEETING

A national open meeting is the main consultative phase of SIGN guideline development, at which the guideline development group presents their draft recommendations for comment. The national open meeting for this guideline was held in March 2001 and was attended by representatives of all the key specialties relevant to the guideline. The draft guideline was also available on the SIGN web site for a limited period at this stage to allow those unable to attend the meeting to contribute to the development of the guideline.

8.3.2 SPECIALIST REVIEW

The guideline was reviewed in draft form by a panel of independent expert referees, who were asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence base supporting the recommendations in the guideline. SIGN is grateful to all of these experts for their contribution to this guideline.

Professor Annie Anderson, Faculty of Epidemiology & Public Health, University of Dundee
Mrs Mandy Andrew Cardiovascular Facilitator, Perth & Kinross LHCC and Tayside PCT
Dr Jenny Bell, Director, BACR Phase 4 Education Project
Dr Hugh Bethell, General Practitioner, Alton
Mrs Lesley Brooks, Cardiac Specialist Nurse, Perth Royal Infirmary
Professor Sir Charles George, Medical Director, British Heart Foundation, London
Dr John Irving, Consultant Cardiologist, St Johns Hospital, Livingston
Professor Marie Johnston, Professor of Health Psychology, St Andrews University
Dr Kate Jolly, Department of Public Health & Epidemiology, University of Birmingham
Professor Bob Lewin, British Heart Foundation Rehabilitation Research Unit, University of York
Professor Richard Mayou, Department of Psychiatry, University of Oxford
Dr Andrew McLeod, Consultant Cardiologist, Poole Hospital NHS Trust
Dr Allan Merry, General Practitioner, Ardrossan
Dr Jill Pell, Consultant in Public Health Medicine, Greater Glasgow Health Board
Dr Ann Taylor, Physiotherapy Division, King's College London
Dr Rod Taylor, Senior Lecturer in Public Health, University of Birmingham
Mrs Joan Thain, Health Visitor, Westburn Centre, Aberdeen
Professor David Thompson, Department of Health Studies, University of York
Professor Erkki Vartiainen, National Public Health Institute, Finland
Dr Alex Watson, General Practitioner, Dundee

8.3.3 SIGN EDITORIAL GROUP

The guideline was then reviewed by an Editorial Group comprising relevant specialty representatives on SIGN Council, to ensure that the peer reviewers' comments had been addressed adequately and that any risk of bias in the guideline development process as a whole had been minimised. The Editorial Group for this guideline was as follows:

Dr David Alexander, British Medical Association Scottish General Practice Committee
Dr Jim Beattie, Royal College of General Practitioners
Dr Doreen Campbell, CRAG Secretariat, Scottish Executive Department of Health
Mrs Patricia Dawson, Royal College of Nursing
Professor Gordon Lowe, Chairman of SIGN, Co-Editor
Ms Juliet Miller, Director of SIGN, Co-Editor
Miss Tracy Nairn, National Paramedical Advisory Committee
Dr Sara Twaddle, Health Economics Adviser to SIGN
Dr Bernice West, National Nursing, Midwifery & Health Visiting Advisory Committee