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 study in the February 25 issue of JAMA.
Clinical practice guidelines are often assumed to be the standard of evidence-based medicine, the article reports. 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 includes A (higher level of evidence), B, and C (lower level of evidence). The class of recommendation designation includes I (evidence that a treatment or procedure is effective), II, IIa, IIb and III (evidence that a treatment or procedure is not effective).
The study’s authors evaluated the adequacy of evidence behind current guideline recommendations. They found that among all 1,305 class I recommendations of guidelines reporting level of evidence, only 245 have level of evidence A, with 481 having a level of evidence C. “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,” the authors conclude.
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