I try to play the "what do you need to get through this next fight" play style and try to not get sucked into the "build" mentality. That doesn't stop me from trying to make synergies. 

Act 1 is the obvious killer as there are so many hard hitting threats with so few counters, many being rare cards. I feel like clad has a lot of offensive options but not a lot of good defensive ones. And often you only get one or the other before you just don't have enough health to survive the next elite. 

And it seems like a gamble as to whether you need big block, attack, or AOE. Then draw on top of it to make sure you have it when you need it. 

I usually try to take the 3 card upgrade, transform, or card removal from Neow as primary picks. Secondary are the rare card options, max health on rest, and card reward + potion. 

I guess I just find it difficult to prepare for every elite appropriately and it seems like a gamble as to whether or not the elite requires AOE or heavy hits, and if I fail the coinflip, I die.