Evidence is reviewed at least twice a year, and updates are initi- ated on an as-needed basis and completed as quickly as possible while maintaining the rigorous methodology that the ACC and AHA have developed during their partnership of >20 years. A focused update is initiated when new data that are deemed potentially important for patient care are published or presented at national and international meetings (Section 1.1, Methodology and Evidence Review ). Through a broad- based vetting process, the studies included are identified as being important to the relevant patient population. The focused update is not intended to be based on a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that may effect changes in current recommendations. Specific criteria or consider- ations for inclusion of new data include the following: Publication in a peer-reviewed journal; Large, randomized, placebo-controlled trial(s); Nonrandomized data deemed important on the basis of results affecting current safety and efficacy assumptions, including observational studies and meta-analyses; Strength/weakness of research methodology and findings; Likelihoodofadditionalstudiesinfluencingcurrentfindings; Impact on current performance measures and/or likeli- hood of need to develop new performance measure(s); Request(s) and requirement(s) for review and update from the practice community, key stakeholders, and other sources free of industry relationships or other potential bias; Number of previous trials showing consistent results; and Need for consistency with a new guideline or guideline updates or revisions. 