Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines
Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines
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DOI：
10.1001/jama.2009.205
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发表时间：
2009-02-25
影响因子：
120.7
通讯作者：
Smith, Sidney C., Jr.
中科院分区：
文献类型：
--
作者：
Tricoci, Pierluigi;Allen, Joseph M.;Smith, Sidney C., Jr.
美国心脏病学会（ACC）和美国心脏协会（AHA）的联合心血管实践指南已成为指导心脏病学实践和建立护理质量基准的重要文件。AHA心血管指南以及建议在建议类别和证据等级之间的分布。数据来源和研究从1984年至2008年9月发布的所有ACC/ AHA实践指南中的选择数据由ACC科学和质量部门的人员提取。对22个主题的53个指南，包括总共7196条建议进行了提取。数据提取确定了建议的数量和建议类别（I、II和III）的分布以及证据等级（A、B和C）。评估了截至2008年9月的指南子集，以描述第一版和当前版本之间的建议变化以及当前版本中使用的证据水平模式。从第一版到当前版本，建议的数量从1330个增加到1973个（+ 48%），其中II类建议的使用增加最多。考虑到报告证据等级的16个现行指南，总共2711条建议中只有314条被归类为证据等级A（中位数，11%），而1246条（中位数，48%）被归类为证据等级C。证据水平在指南类别（疾病、干预或诊断）和个体指南之间存在显著差异。证据水平A的建议大多集中在I类，但只有245 1305 I类建议的证据水平A（中位数，19%）。结论建议在目前的ACC/ AHA临床实践指南中发布的主要是从较低的证据水平或专家意见。没有确凿证据的建议所占比例也在增加。这些发现强调了需要改进指南的编写过程，并扩大临床实践指南的证据基础。
Context The joint cardiovascular practice guidelines of the American College of Cardiology ( ACC) and the American Heart Association ( AHA) have become important documents for guiding cardiology practice and establishing benchmarks for quality of care.Objective To describe the evolution of recommendations in ACC/ AHA cardiovascular guidelines and the distribution of recommendations across classes of recommendations and levels of evidence.Data Sources and Study Selection Data from all ACC/ AHA practice guidelines issued from 1984 to September 2008 were abstracted by personnel in the ACC Science and Quality Division. Fifty- three guidelines on 22 topics, including a total of 7196 recommendations, were abstracted.Data Extraction The number of recommendations and the distribution of classes of recommendation ( I, II, and III) and levels of evidence ( A, B, and C) were determined. The subset of guidelines that were current as of September 2008 was evaluated to describe changes in recommendations between the first and current versions as well as patterns in levels of evidence used in the current versions.Results Among guidelines with at least 1 revision or update by September 2008, the number of recommendations increased from 1330 to 1973 ( + 48%) from the first to the current version, with the largest increase observed in use of class II recommendations. Considering the 16 current guidelines reporting levels of evidence, only 314 recommendations of 2711 total are classified as level of evidence A ( median, 11%), whereas 1246 ( median, 48%) are level of evidence C. Level of evidence significantly varies across categories of guidelines ( disease, intervention, or diagnostic) and across individual guidelines. Recommendations with level of evidence A are mostly concentrated in class I, but only 245 of 1305 class I recommendations have level of evidence A ( median, 19%).Conclusions Recommendations issued in current ACC/ AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing. These findings highlight the need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived.