Developing AHA ECC recommendation informed by GRADE weak recommendation in favor of therapy or diagnostic or prognostic test

This flowchart depicts what can happen when developing an AHA ECC recommendation informed by a GRADE weak recommendation in favor of therapy or a diagnostic or prognostic test. (“ECC” is the acronym for “Emergency Cardiovascular Care.” “GRADE” is an acronym that stands for “Grading of Recommendations Assessment, Development, and Evaluation.”) This flowchart includes six boxes. There are two boxes of origin. One is labeled “GRADE weak recommendation in favor, with high or moderate evidence.” The other is labeled “GRADE weak recommendation in favor, with low or very low evidence.” Both boxes of origin have dashed arrows labeled “Unlikely” pointing to a box titled “Convert to AHA ECC Class 1 (Strong) Recommendation If Benefit [is substantially greater than] Risk.” The text description states: “Therapy or test is “recommended or indicated, effective or beneficial, should be done.” This applies to therapies or tests that are considered the standard of care or that should generally be provided or used for the vast majority of patients. Writing group should document rationale for difference from ILCOR GRADE (for example, is it as a result of patient subset or specific conditions?).” (“ILCOR” is an acronym that stands for “International Liaison Committee on Resuscitation.”) Both boxes of origin have solid arrows labeled “Maybe” pointing to a box titled “Convert to AHA ECC Class 2 A (Moderate) Recommendation If Benefit [is somewhat greater than] Risk.” The text description states: “Therapy or test is “probably recommended, is reasonable, can be useful, effective, or beneficial.” It is appropriate for most patients, with some exceptions.” Both boxes of origin have solid arrows labeled “Probably” pointing to a box titled “Convert to AHA ECC Class 2 B (Weak) Recommendation If Benefit [is greater than or equal to] Risk.” The text description states: “Therapy or test is “recommended or indicated, effective or beneficial, should be done.” This applies to therapies or tests that are considered the standard of care or that should generally be provided or used for the vast majority of patients. Writing group should document rationale for difference from ILCOR GRADE (for example, is it as a result of patient subset or specific conditions?).” Only the box of origin labeled “GRADE weak recommendation in favor, with high or moderate evidence” leads to the final box. A solid arrow labeled “Maybe” points to this box titled “AHA ECC Class 3: No Benefit If Benefit [equals] Risk.” The text description notes in bold: “This class generally requires Level of Evidence (or L.O.E.) A or B (not C or E) evidence documenting lack of benefit.” It goes on to state: “If ECC experts agree there is no benefit for groups or subgroups, the writing group chain should share this information or interpretation with ILCOR task force representative and note rationale in Guidelines. If you wish to assign this Class with only L.O.E. C or E evidence, provide rationale in the Guidelines.” (“L.O.E.” is an acronym that stands for “Level of Evidence.”) This figure is copyright 2015 by the American Heart Association. There is a caption beneath this Figure which reads: “Developing an AHA ECC recommendation that is informed by a GRADE weak recommendation in favor of a therapy or diagnostic or prognostic test.”