Coronary Anomalies e767 Anomalous Coronary Artery Evaluation e768 Anomalous Aortic Origin of Coronary Artery e769 Anomalous Coronary Artery Arising From the PA e769 4.4.8. Coronary Artery Fistula e770 5. Evidence Gaps and Future Directions e772 References e773 Appendix 1 Author Relationships With Industry and Other Entities (Relevant) e796 Appendix 2 Reviewer Relationships With Industry and Other Entities (Comprehensive) e798 CLINICAL STATEMENTS AND GUIDELINES PREAMBLE Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translat- ed scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardio- vascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality cardiovascular care. The ACC and AHA sponsor the development and pub- lication of guidelines without commercial support, and members of each organization volunteer their time to the writing and review efforts. Guidelines are official policy of the ACC and AHA. Intended Use Practice guidelines provide recommendations applica- ble to patients with or at risk of developing cardiovas- cular disease. The focus is on medical practice in the United States, but guidelines developed in collabora- tion with other organizations can have a global impact. Although guidelines may be used to inform regulatory or payer decisions, they are intended to improve pa- tients quality of care and align with patients interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances and should not replace clinical judgment. Clinical Implementation Management in accordance with guideline recommenda- tions is effective only when followed by both practitioners and patients. Adherence to recommendations can be enhanced by shared decision-making between clinicians and patients, with patient engagement in selecting in- terventions on the basis of individual values, preferences, and associated conditions and comorbidities. 