Heart care guidelines rarely backed by solid evidence

  • Fanaroff AC & al.
  • JAMA
  • 19 Mar 2019

  • International Clinical Digest
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Takeaway

  • Recommendations from major cardiovascular societies are most often not supported by findings from randomized controlled trials (RCTs), suggesting a weak evidence base.

Why this matters

  • Clinicians rely on guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology as cornerstones of clinical decision-making, so a weak evidence base is cause for concern.
  • Editorial notes that a low level of evidence (LOE) underlying many class I recommendations is a “contentious point” and asks if these class I recommendations can be justified.

Key results

  • Only 248 (8.5%) of 2930 recommendations in 26 available ACC/AHA guidelines are LOE A (supported by multiple RCTs).
  • Only 484 (14.2%) of 3399 recommendations from 25 available ESC guidelines are LOE A.
  • Comparison of median rates with those from previous guidelines showed little difference:
    • ACC/AHA: current, 9.0% vs 11.7% previous;
    • ESC: current, 15.1% vs 17.6% previous.
  • In the past 2 years, only 5.7% of ACC/AHA recommendations were LOE A.
  • Vs ACC/AHA, ESC recommendations have a higher proportion of class 1, LOE A recommendations.

Study design

  • Guidelines comparison.
  • Outcome: proportion with LOE A.
  • Funding: Not specified; some authors report industry ties. 

Limitations

  • Does not include guidelines updates focused on a few select recommendations.