Canadian Cardiovascular Society atrial fibrillation guidelines 2010: implementing GRADE and achieving consensus

This article describes the process of the Canadian Cardiovascular Society 2010 atrial fibrillation (AF) guidelines update. Guideline development was based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system of evaluation. GRADE separates the quality of evidence (very low, low, moderate, or high quality) from the strength of recommendations (strong or conditional, ie, weak). GRADE allows acknowledgement of values and preferences in the provision of clinical care as well as costs of interventions in determining the strength of recommendations. Disclosures of relationships with industry or other potential conflicts of interest were reported at the outset and annually. Each recommendation was approved by at least a two-thirds majority of the voting panel (those with a significant conflict recusing themselves from voting on those specific recommendations).