lines have the potential to become indicators of disability as defined by SSA,” that is, to determine whether the guidelines would be useful in developing listing criteria for evaluating disability. The guidelines identified by ACC/AHA are listed in Box C-1.

ACC Briefing of IOM Committee

James Fasules, M.D., senior vice president, advocacy, American College of Cardiology, participated in the first committee meeting to discuss the role of the ACC/AHA clinical practice guidelines in updating SSA’s cardiovascular disability criteria in the Listings. He indicated four potential contributions of the guidelines:

  1. Comprehensive review of natural history of disease process;

  2. Explicit guidance on activity restrictions and capabilities—a direct bearing on disability;

  3. Consistent terminology for conditions and diagnostic and therapeutic services; and

  4. Guidance on standard of care for evaluation and treatment.

The guidelines were relied on extensively in the report as the basis for descriptive, diagnostic, and treatment terminology for the diagnostic procedures and tests and recommended treatments that should be expected to be in the average medical record and required or assumed in the listing criteria, and for information about the natural history of each condition. They were also reviewed to see if they provided any guidance on activity limitations and capacity, which relate directly to disability criteria. Few of the guidelines contained this information.


IOM staff reviewed the clinical guidelines listed in the ACC/AHA letter and, in addition, the guidelines for valvular heart disease. The clinical guidelines for the diagnosis and management of heart failure in adults had been updated in 2009; they were reviewed in this analysis instead of the earlier one cited in the ACC/AHA letter.

The first step was to search each guideline for any mention of the impact of the heart condition or its treatment on a person’s capacity to engage in gainful activity, using terms such as employment, return to work, or work capacity. An electronic copy was scanned for the following terms:

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