In recent years, a new approach to evidence synthesis emerged, resulting in what are called ‘living guidelines’ (Cheyne et al. 2023. El Mikati et al. 2022). Living guidelines are the output of ongoing systematic reviews, that allow the most up-to-date evidence in the field to be quickly integrated into recommendations. They combine the methodological rigour of established best practice in guideline development, with the ability to nimbly respond to changes in the evidence, guideline users’ needs, or the broader healthcare context, to ensure recommendations are current, valid and relevant.

In 2017, the Stroke Foundation in Australia started their guidelines on stroke care, the world’s first living guidelines (English et al. 2022). The COVID-19 pandemic increased the pace of living guideline development. The Australian Living Evidence Collaboration (ALEC), the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) all chose to implement a living approach to keep up with the rapidly growing body of research and to produce up-to-date recommendations on COVID-19. Guideline developers internationally are now developing living guidelines on many different topics. For example, ALEC is currently developing many more living guidelines, including for topics such as inflammatory arthritis, type 1 diabetes, kidney disease and pregnancy and postnatal care.

Guideline developers can create a living guideline from the beginning (involving first developing a conventional guideline and then making it living), or adapt and change an existing published guideline to a living approach. Either way, guideline developers may select specific questions or recommendations that are appropriate for a living approach, rather than committing to keeping all recommendations up to date (Cheyne et al. 2023). The decisions to use a living guideline approach are based on whether the recommendations are a high priority, if new evidence is likely to change recommendations, and if new evidence is expected (Akl et al. 2017). Living guidelines may consist of a single guideline, or a set of guidelines covering a common area.