New Evidence, New Controversies: a Critical Review of the European Society of Cardiology 2010 Clinical Practice Guidelines on Atrial Fibrillation

2012 ◽  
Vol 65 (1) ◽  
pp. 7-13
Author(s):  
Manuel Anguita ◽  
Fernando Worner ◽  
Pere Domenech ◽  
Francisco Marín ◽  
Javier Ortigosa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Critical Review ◽  
European Society Of Cardiology ◽  
New Evidence

P1659Evolution of level of evidence c recommendations in European Society of Cardiology clinical practice guidelines on heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Trindade ◽  
D Faria ◽  
J Serodio ◽  
F Batista ◽  
M Beringuilho ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Quality Data ◽  
Level Of Evidence ◽  
Group 2 ◽  
European Society Of Cardiology ◽  
Group 1

Abstract Background Over the past two decades, the European Society of Cardiology (ESC) Clinical Practice Guidelines (CPG) on Heart Failure has increasingly become a familiar part of Cardiology practice and are used worldwide. By creating objective standards, CPG provides a mechanism to assess decision-making and straightforward references for clinicians. Level of Evidence C recommendations are based on expert consensus and/or small retrospective studies and registries with limited and non-representative populations evaluated. The resulting directives need to be proven with better quality data to assess its true benefits. Purpose The purpose of our study was to describe and evaluate the evolution of Level of Evidence C recommendations of ESC CPG on Heart Failure and to provide a quality assessment of its benefits in the following years. Methods In this retrospective observational Case-Control study, we identified and collected all Level of Evidence C recommendations in five consecutive published documents of ESC CPG in the years 2001, 2005, 2008, 2012 and 2016. Each identified recommendation was classified between two major groups: Diagnostic and Complementary Exams (group 1) and Therapeutics and Interventions (group 2) and was followed up in the following documents. Primary outcomes were classified as: (1) Upgrade to Level of Evidence A or B [Upgrade], (2) Elimination or disproven benefit/harm [Downgrade] and (3) Maintenance or minor reformulation with unchanged benefit/harm [Maintenance]. We applied a Kaplan-Meyer survival analysis to estimate the probability of Upgrade or Downgrade in each group. Results A total of 239 different Level of Evidence C recommendations were submitted to the final analysis, 22.6% (n=54) in group 1 and 77.4% (n=185) in group 2. On follow-up, 35.2% (n=76) of recommendations were upgraded, 29.6% (n=64) were downgraded and 35.2% (n=76) were maintained. Regarding outcomes, the downgrade of recommendations occurred predominantly in group 2 (94.4%). Considering all the eliminated recommendations, 60.9% took place on the next following published ESC CPG document. Likewise, 60.5% of upgraded recommendations also occurred on the next following published ESC CPG document. The probability of upgrade or downgrade in the next following document was 52.8%, predominantly in the Therapeutics and Interventions group (37.5% vs 57.9%, p=0.012). Figure 1 Conclusions Level of Evidence C recommendations constitutes an important asset of ESC CPG on Heart Failure as they are usually updated on new treatment options and are developed by experts in the specific topic. However, the probability of elimination due to disproven benefit or potential harm was high (29.6%), particularly regarding therapeutics and interventions (94%). Since a significant fraction of Level of Evidence C recommendations remains unchanged on the following document (35%), the need for high-quality data, specifically regarding therapeutic interventions, is warranted.

scholarly journals Concordance of recommendations across clinical practice guidelines for the management of hypertension in Southeast Asia with internationally reputable sources

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chia Siang Kow ◽  
Syed Shahzad Hasan ◽  
Pei Se Wong ◽  
Rohit Kumar Verma
Keyword(s):  
Clinical Practice ◽  
Southeast Asia ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Heart Association ◽  
Standard Of Care ◽  
High Rate ◽  
The Individual ◽  
European Society Of Cardiology

Abstract Objectives This study aimed to assess the rate of concordance, and to investigate sources of non-concordance of recommendations in the management of hypertension across CPGs in Southeast Asia, with internationally reputable clinical practice guidelines (CPGs). Methods CPGs for the management of hypertension in Southeast Asia were retrieved from the websites of the Ministry of Health or cardiovascular specialty societies of the individual countries of Southeast Asia during November to December 2020. The recommendations for the management of hypertension specified in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guideline were selected to be the reference standards; the recommendations concerning the management of hypertension in the included CPGs in Southeast Asia were assessed if they were concordant with the reference recommendations generated from both the 2017 ACC/AHA guideline and the 2018 ESC/ESH guideline, using the population (P)-intervention (I)-comparison (C) combinations approach. Results A total of 59 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2017 ACC/AHA guideline. In addition, a total of 51 reference recommendations with unique and unambiguous P-I-C specifications was generated from the 2018 ESC/ESH guideline. Considering the six included CPGs from Southeast Asia, concordance was observed for 30 reference recommendations (50.8%) out of 59 reference recommendations generated from the 2017 ACC/AHA guideline and for 31 reference recommendations (69.8%) out of 51 reference recommendations derived from the 2018 ESC/ESH guideline. Conclusions Hypertension represents a significant issue that places health and economic strains in Southeast Asia and demands guideline-based care, yet CPGs in Southeast Asia have a high rate of non-concordance with internationally reputable CPGs. Concordant recommendations could perhaps be considered a standard of care for hypertension management in the Southeast Asia region.

scholarly journals 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation: what is new for neurologists?

2021 ◽  
Vol 27 (1) ◽  
pp. 7-15
Author(s):  
S. N. Yanishevskiy ◽  
I. B. Skiba ◽  
A. Y. Polushin
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cryptogenic Stroke ◽  
Original Position ◽  
Diagnosis And Management ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Clinical practice guidelines for the diagnosis and management of atrial fibrillation (AF) are one of the most regularly updated documents by the European Society of Cardiology. The new version of clinical practice guidelines (2020) contains a number of changes regarding anticoagulant therapy in patients with AF who have developed acute cerebrovascular accidents. In this review, we discuss the statements of the updated document on the timing of the start/restart of anticoagulant therapy after ischemic stroke and intracranial hemorrhage in patients with AF, the choice of antithrombotic therapy in patients with cryptogenic stroke, as well as the need for the additional testing to clarify the origin of the embolism. We provide our original position on the possibility of applying these recommendations to the real clinical practice.

Cardiovascular Medicine

2019 ◽  
Author(s):  
Dominik Vogel
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
European Society ◽  
Full Text ◽  
Cardiovascular Medicine ◽  
European Society Of Cardiology

The field of cardiovascular medicine is an inexhaustible source for clinical trials (→ OHCM 10th edition:). The most feasible way of keeping up to date is referring to guidelines. In addition to those made avail­able by the National Institute for Health and Care Excellence (NICE), the European Society of Cardiology (ESC) provides very useful Clinical Practice Guidelines that are accessible via: https://www.escardio.org/ Guidelines/Clinical-Practice-Guidelines. If you don’t manage to read the full text of each of the provided guide­lines, you might find the ‘summary cards’ useful that you can download for free using the same link.

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