ACC AHA guidelines classification scheme

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The Class designation is used to indicate whether a therapy is recommended or not and the certainty surrounding that recommendation.

Classification of Recommendations

Class I: Benefit >>> Risk

Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective.

Class II:

Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.

Class IIa: Benefit >> Risk

Weight of evidence/opinion is in favor of usefulness/efficacy.

Class IIb: Benefit ≥ Risk

Usefulness/efficacy is less well established by evidence/opinion.

Class III: Risk ≥ Benefit

Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful.

Class III: No Benefit

Is not recommended, not indicated, should not be performed/ administered/ other. Is not useful/beneficial/effective.

Class III: Harm

Potentially harmful, causes harm, associated with excess morbidity/mortality. Should not be performed/administered/other.

Use the Level of Evidence designation to indicate the strength of the data associated with that recommendation.

Level of Evidence

Level of Evidence A:

Data derived from multiple randomized clinical trials or meta-analyses.

Level of Evidence B:

Data derived from a single randomized trial, or nonrandomized studies.

Level of Evidence C:

Only consensus opinion of experts,case studies, or standard-of-care.

Applying Classification of Recommendations and Level of Evidence

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