Featured Research

from universities, journals, and other organizations

Guidelines For Treating Patients With Cardiovascular Disease Often Based On Weaker Evidence

Date:
February 24, 2009
Source:
JAMA and Archives Journals
Summary:
An examination of clinical practice guidelines for treating cardiovascular disease finds that current recommendations are largely based on lower levels of evidence or expert opinion.

An examination of clinical practice guidelines for treating cardiovascular disease finds that current recommendations are largely based on lower levels of evidence or expert opinion, according to a new study.

Related Articles


Clinical practice guidelines are developed to assist practitioners with decisions about appropriate health care for specific patients' circumstances, and are often assumed to be the standard of evidence-based medicine, according to background information in the article.

For more than 20 years, the American College of Cardiology (ACC) and the American Heart Association (AHA) have released clinical practice guidelines to provide recommendations on care of patients with cardiovascular disease. The ACC/AHA guidelines currently use a grading scheme based on level of evidence and class of recommendation. The level of evidence classification combines an objective description of the existence and the types of studies supporting the recommendation and expert consensus, and are categorized as A (higher level of evidence), B, or C [lower level of evidence).

The class of recommendation designation indicates the strength of a recommendation and requires guideline writers not only to make a judgment about the relative strengths and weaknesses of the study data but also to make a value judgment about the relative importance of the risks and benefits identified by the evidence. Classes include I (evidence that a treatment or procedure is effective), II, IIa, IIb and III (evidence that a treatment or procedure is not effective).

Whether the increase in publication of studies concerning cardiovascular disease has resulted in guideline recommendations with more certainty and supporting evidence is not known. Pierluigi Tricoci, M.D., M.H.S., Ph.D., of Duke University, Durham, N.C., and colleagues examined the changes in recommendations in ACC/AHA cardiovascular guidelines and evaluated the adequacy of evidence behind current guideline recommendations. The analysis included data from ACC/AHA practice guidelines issued from 1984 to September 2008. Fifty-three guidelines on 22 topics, including a total of 7,196 recommendations, were examined.

Considering only the current guidelines with at least 1 revision, the total number of recommendations has increased from 1,330 to 1,973 (48 percent increase) from the first guideline to the current version. Overall, the guidelines shifted to more class II recommendations and fewer class III recommendations, while the use of class I recommendations remained fairly constant over time. The 16 current guidelines reporting levels of evidence, comprising a total of 2,711 recommendations, classify 314 recommendations as level of evidence A (median [midpoint], 11 percent), and 1,246 with level of evidence C (median, 48 percent).

Among all 1,305 class I recommendations of guidelines reporting level of evidence, only 245 have level of evidence A (median, 19 percent), with 481 (median, 36 percent) having a level of evidence C. Level of evidence significantly varies across categories of guidelines (disease, intervention, or diagnostic) and across individual guidelines.

"Our finding that a large proportion of recommendations in ACC/AHA guidelines are based on lower levels of evidence or expert opinion highlights deficiencies in the sources of definitive data available for the generation of cardiovascular guidelines. To remedy this problem, the medical research community needs to streamline clinical trials, focus on areas of deficient evidence, and expand funding for clinical research. In addition, the process of developing guidelines needs to be improved with information about the impact that recommendations based on lower levels of evidence has on clinical practice. Finally, clinicians need to exercise caution when considering recommendations not supported by solid evidence," the authors conclude.

Editorial: Reassessment of Clinical Practice Guidelines - Go Gently Into That Good Night

In an accompanying editorial, Terrence M. Shaneyfelt, M.D., M.P.H., and Robert M. Centor, M.D., of the University of Alabama School of Medicine, Birmingham, write that if clinical practice guidelines are going to continue to exist, they need to undergo major changes.

"However, it seems unlikely that substantial change will occur because many guideline developers seem set in their ways. If all that can be produced are biased, minimally applicable consensus statements, perhaps guidelines should be avoided completely. Unless there is evidence of appropriate changes in the guideline process, clinicians and policy makers must reject calls for adherence to guidelines. Physicians would be better off making clinical decisions based on valid primary data."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Pierluigi Tricoci; Joseph M. Allen; Judith M. Kramer; Robert M. Califf; Sidney C. Smith, Jr. Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines. JAMA, 2009;301(8):831-841 [link]

Cite This Page:

JAMA and Archives Journals. "Guidelines For Treating Patients With Cardiovascular Disease Often Based On Weaker Evidence." ScienceDaily. ScienceDaily, 24 February 2009. <www.sciencedaily.com/releases/2009/02/090224163606.htm>.
JAMA and Archives Journals. (2009, February 24). Guidelines For Treating Patients With Cardiovascular Disease Often Based On Weaker Evidence. ScienceDaily. Retrieved November 23, 2014 from www.sciencedaily.com/releases/2009/02/090224163606.htm
JAMA and Archives Journals. "Guidelines For Treating Patients With Cardiovascular Disease Often Based On Weaker Evidence." ScienceDaily. www.sciencedaily.com/releases/2009/02/090224163606.htm (accessed November 23, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, November 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

AFP (Nov. 23, 2014) The arable district of Kenema in Sierra Leone -- at the centre of the Ebola outbreak in May -- has been under quarantine for three months as the cocoa harvest comes in. Duration: 01:32 Video provided by AFP
Powered by NewsLook.com
Don't Fall For Flu Shot Myths

Don't Fall For Flu Shot Myths

Newsy (Nov. 23, 2014) Misconceptions abound when it comes to your annual flu shot. Medical experts say most people older than 6 months should get the shot. Video provided by Newsy
Powered by NewsLook.com
WFP: Ebola Risks Heightened Among Women Throughout Africa

WFP: Ebola Risks Heightened Among Women Throughout Africa

AFP (Nov. 21, 2014) Having children has always been a frightening prospect in Sierra Leone, the world's most dangerous place to give birth, but Ebola has presented an alarming new threat for expectant mothers. Duration: 00:37 Video provided by AFP
Powered by NewsLook.com
Could Your Genes Be The Reason You're Single?

Could Your Genes Be The Reason You're Single?

Newsy (Nov. 21, 2014) Researchers in Beijing discovered a gene called 5-HTA1, and carriers are reportedly 20 percent more likely to be single. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins