From the Guidelines
A Class I recommendation is a strong recommendation indicating that a specific treatment, procedure, or intervention should be performed or administered because it is considered beneficial, useful, and effective, with the benefit greatly outweighing the risk, as stated in the 2024 ACC/AHA clinical performance and quality measures for adults with valvular and structural heart disease 1.
Definition of Class I Recommendation
A Class I recommendation is the strongest recommendation, indicating the writing group’s judgment that the benefit of an intervention greatly outweighs its risk.
- This designation means there is strong evidence and/or general agreement that the intervention provides substantial benefit that outweighs any potential harm.
- Class I recommendations represent the standard of care in medicine and are typically associated with improved patient outcomes.
- The strength of this recommendation is based on high-quality evidence from multiple randomized controlled trials, meta-analyses, or well-designed observational studies that consistently demonstrate significant clinical benefit, as outlined in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 2.
Key Characteristics of Class I Recommendations
- Benefit greatly outweighs risk
- Strong evidence and/or general agreement
- Standard of care in medicine
- Typically associated with improved patient outcomes
- Based on high-quality evidence from multiple randomized controlled trials, meta-analyses, or well-designed observational studies ### Clinical Implications When clinicians encounter a Class I recommendation in practice guidelines, they should implement it for eligible patients in most circumstances unless there are compelling reasons not to do so, as noted in the management of mitral stenosis: a systematic review of clinical practice guidelines and recommendations 3.
- Class I recommendations are considered appropriate for the vast majority of clinicians to follow for the vast majority of patients, with infrequent exceptions based upon the judgment of practitioners in the context of the circumstances of individual cases.
From the Research
Definition of Class I Recommendation
- A Class I recommendation is defined as a strong recommendation based on high-quality evidence, indicating that the benefits of the treatment or intervention clearly outweigh the risks 4.
- The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care 4.
- In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation 4.
Key Characteristics of Class I Recommendation
- High-quality evidence: The evidence is considered high quality if it is based on well-designed and well-conducted studies, with a low risk of bias 4.
- Strong recommendation: A strong recommendation indicates that the benefits of the treatment or intervention clearly outweigh the risks, and that most patients would choose to receive the treatment 4.
- Clear benefits: The benefits of the treatment or intervention are clearly established, and the risks are minimal or well-managed 4.