SIGN 97: Risk estimation and the prevention of cardiovascular disease

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14 Development of the guideline

14.1 Introduction

SIGN is a collaborative network of clinicians, other healthcare professionals and patient organisations and is part of NHS Quality Improvement Scotland. SIGN guidelines are developed by multidisciplinary groups of practicing clinicians 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", available at

14.2 The guideline development group

Dr James Grant (Chair) General Practitioner, Auchterarder
Mrs Brenda Anderson Cardiac Rehabilitation Co-ordinator, Aberdeen Royal Infirmary
Mrs Mandy Andrew Tayside Managed Clinical Network Manager, CHD, Dundee
Professor Christine Bond Consultant in Pharmaceutical Public Health, University of Aberdeen
Dr Adrian Brady Consultant Cardiologist, Glasgow Royal Infirmary
Dr Neil Campbell Reader in General Practice, Department of General Practice and Primary Care, University of Aberdeen
Ms Joyce Craig Senior Health Economist, NHS Quality Improvement Scotland
Dr John Dick Consultant Physician, Ninewells Hospital, Dundee
Dr Penelope Fraser Consultant Clinical Psychologist, Ninewells Hospital, Dundee
Mr James Grant Lay Representative, Balerno
Ms Marianne Hayward Managed Clinical Network Manager for diabetes, Greater Glasgow Health Board
Dr Matthew Lowther Heart Health Network Co-ordinator, NHS Health Scotland
Dr Jill Murie General Practitioner Principal, Forth
Dr Moray Nairn Programme Manager, SIGN Executive
Professor Rudolph Riemersma Consultant Biochemist, University of Edinburgh
Ms Ann Ross Physiotherapist, Western Infirmary, Glasgow
Mr Duncan Service Senior Information Officer, SIGN Executive
Dr Indrani Sinnak-Aruppan Consultant Clinical (Neuro and Health) Psychologist, Ayrshire Central Hospital
Mr Roger Stableford Lay Representative, Falkirk
Ms Nicola Stuckey Consultant Clinical Psychologist, Astley Ainslie Hospital, Edinburgh
Ms Joan Thain Cardiac Rehabilitation Health Visitor, Westburn Centre, Aberdeen
Dr Deborah Tinson Consultant Clinical Psychologist, Astley Ainslie Hospital, Edinburgh
Dr Iain C Todd Consultant in Cardiovascular Rehabilitation, Astley Ainslie Hospital, Edinburgh

The membership of the guideline development group was confirmed following consultation with the member organisations of SIGN. All members of the guideline development group made declarations of interest and further details of these are available on request from the SIGN Executive. Guideline development and literature review expertise, support and facilitation were provided by the SIGN Executive.

14.3 The risk estimation subgroup

A small subgroup was established to evaluate methods of estimating cardiovascular risk and to incorporate a measure of social deprivation into a new risk estimation tool.

Dr James Grant (Chair) General Practitioner, Auchterader
Dr Adrian Brady Consultant Cardiologist, Glasgow Royal Infirmary
Dr Peter Brindle Welcome Training Fellow in Health Service Research, University of Bristol
Ms Joyce Craig Senior Health Economist, NHS Quality Improvement Scotland
Mr Alex McConnachie Consultant Statistician, University of Glasgow
Dr Moray Nairn Programme Manager, SIGN Executive
Dr Adam Redpath Programme Principal for Coronary Heart Disease and Stroke, Information and Statistics Division, NHS Scotland
Mr Roger Stableford

Patient Representative, Falkirk

Professor Hugh Tunstall-Pedoe Professor of Cardiovascular Epidemiology, Ninewells Hospital, Dundee
Professor Graham Watt Professor of General Practice, University of Glasgow

14.4 The steering group

A steering group comprising the chairs of the five SIGN CHD guidelines and other invited experts was established to oversee the progress of the guideline development. This group met regularly throughout the lifetime of the guidelines.

Dr Kevin Jennings Co-chair and Consultant Cardiologist, Aberdeen Royal Infirmary
Professor Lewis Ritchie Co-chair and Mackenzie Professor of General Practice, University of Aberdeen
Dr Alan Begg Chair of SIGN stable angina guideline
Dr Nick Boon Consultant Cardiologist, Royal Infirmary of Edinburgh
Ms Marjory Burns Director for Scotland, British Heart Foundation
Mr David Clark Chief Executive, Chest, Heart and Stroke Scotland
Professor Stuart Cobbe Chair of SIGN arrhthymias guideline
Ms Joyce Craig Senior Health Economist, NHS Quality Improvement Scotland
Dr Iain Findlay Chair of SIGN acute coronary syndromes guideline
Professor Keith Fox Professor of Cardiology, University of Edinburgh
Dr James Grant Chair of SIGN prevention guideline
Mr James Grant Lay representative, Balerno
Dr Grace Lindsay Lecturer, Glasgow Caledonian University
Dr Moray Nairn Programme Manager, SIGN Executive
Professor Allan Struthers Chair of SIGN chronic heart failure guideline
Dr Lorna Thompson Programme Manager, SIGN Executive

14.5 Acknowledgements

SIGN is grateful to the following former members of the guideline development group and others who have contributed to the development of the guideline.

Mr Nicol Rainy Brown Lay Representative, Nairn
Dr Hafrun Taylor Consultant Clinical Psychologist, Astley Ainslie Hospital, Edinburgh
Dr Olivia Wu Systematic Reviewer, Glasgow University
Mr Iain Lowis Head of Community Fundraising, British Heart Foundation, Edinburgh

14.6 Systematic literature review

The evidence base for this guideline was synthesised in accordance with SIGN methodology. A systematic review of the literature was carried out using an explicit search strategy devised by a SIGN Information Officer. Searches were focused on existing guidelines, systematic reviews, randomised controlled trials, and (where appropriate) observational and/or diagnostic studies. Databases searched include Medline, Embase, Cinahl, PsychINFO, and the Cochrane Library. The year range covered was 1999-2005. Internet searches were carried out on various websites including those for the Australian Centre for Clinical Effectiveness, National Institute for Health and Clinical Excellence, the National Library for Health, Swedish Council on Technology Assessment in Healthcare, US Agency for Healthcare Research and Quality, and the US National Guidelines Clearinghouse. The Medline version of the main search strategies can be found on the SIGN website, in the section covering supplementary guideline material. The main searches were supplemented by material identified by individual members of the development group.

Each of the selected papers was evaluated by two members of the group using standard SIGN methodological checklists before conclusions were considered as evidence.

14.7 Consultation and peer review

14.7.1 National open meeting

A national open meeting is the main consultative phase of SIGN guideline development, at which the guideline development group present its draft recommendations for the first time. The national open meeting for the five parallel SIGN guidelines on aspects of cardiovascular disease was held on 16 September 2005 and was attended by over 600 representatives of all the key specialties relevant to the guideline. The draft guideline was also available on the SIGN website for a limited period at this stage to allow those unable to attend the meeting to contribute to the development of the guideline.

14.7.2 Specialist review

This guideline was also reviewed in draft form by the following 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 very grateful to all of these experts for their contribution to the guideline.

Mr James Allison Consultant Clinical Scientist, Aberdeen Royal Infirmary
Professor Iain Broom Consultant in Clinical Biochemistry and Metabolic Medicine, The Robert Gordon University, Aberdeen
Dr John Byrne Consultant Cardiologist, Southern General Hospital, Glasgow
Professor Stuart Cobbe Consultant Cardiologist, Glasgow Royal Infirmary
Mrs Margaret Dunbar Practice Nurse, The Lanark Doctors
Professor Paul Durrington Professor of Medicine, Machester Royal Infirmary
Dr Andrew Elder Consultant in Acute Elderly Medicine, Western General Hospital, Edinburgh
Dr John Gillies General Practitioner, The Health Centre, Selkirk
Ms Patricia Graham Physiotherapist, Stobhill Hospital, Glasgow
Ms Jenny Hally Clinical Research Fellow, University of Dundee
Dr Romana Hunter Lecturer in Dental Prosthetics, University of Dundee
Professor Derek Johnston Professor of Psychology, University of Aberdeen
Mrs Bing Kerr Practice Nurse, Rubislaw Medical Group, Aberdeen
Dr Harpreet Kohli Head of Health Services Research and Development,
Mrs Bing Kerr NHS Quality Improvement Scotland
Dr Dorothy Moir Director of Public Health, NHS Lanarkshire
Professor David Newby British Heart Foundation Reader and Consultan Cardiologist, University of Edinburgh
Professor Chris Packard Professor of Vascular Biochemistry, Glasgow Royal Infirmary
Ms Fiona Reid Pharmacist, NHS Lothian
Dr Leona O?Reilly Acting Project Manager, Scottish Nutrition and Diet Resources Initiative, Glasgow
Mr David Robb Lay Reviewer, Aberdeen
Dr William Simpson Consultant Chemical Pathologist and Head of Service, Aberdeen Royal Infirmary
Dr Falko Sniehotta Lecturer in Psychology, University of Aberdeen
Professor Andrew Tannahill Head of Evidence for Action, NHS Health Scotland

14.7.3 SIGN editorial group

As a final quality control check, the guideline is reviewed by an editorial group comprising the relevant specialty representatives on SIGN Council to ensure that the specialist reviewer?s comments have been addressed adequately and that any risk of bias in the guideline development process as a whole has been minimised. The editorial group for this guideline was as follows.

Dr Keith Brown Member of SIGN Council
Professor Hilary Capell Member of SIGN Council
Mr Robert Carachi Member of SIGN Council
Ms Ann Marie Hawthorne Member of SIGN Council
Dr Bernard Higgins Member of SIGN Council
Professor Gordon Lowe Chairman of SIGN; Co-Editor
Ms Anne Matthew Member of SIGN Council
Dr Safia Qureshi SIGN Programme Director; Co-Editor
Dr Sara Twaddle Director of SIGN; Co-Editor


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