Durability of class I American College of Cardiology/American Heart Association clinical practice guideline recommendations.
Open accessAbstract
IMPORTANCE: Little is known regarding the durability of clinical practice guideline recommendations over time. OBJECTIVE: To characterize variations in the durability of class I ("procedure/treatment should be performed/administered") American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations. DESIGN, SETTING, AND PARTICIPANTS: Textual analysis by 4 independent reviewers of 11 guidelines published between 1998 and 2007 and revised between 2006 and 2013. MAIN OUTCOMES AND MEASURES: We abstracted all class I recommendations from the first of the 2 most recent versions of each guideline and identified corresponding recommendations in the subsequent version. We classified recommendations replaced by less determinate or contrary recommendations as having been downgraded or reversed; we classified recommendations for which no corresponding item could be identified as having been omitted. We tested for differences in the durability of recommendations according to guideline topic and underlying level of evidence using bivariable hypothesis tests and conditional logistic regression. RESULTS: Of 619 index recommendations, 495 (80.0%; 95% CI, 76.6%-83.1%) were retained in the subsequent guideline version, 57 (9.2%; 95% CI, 7.0%-11.8%) were downgraded or reversed, and 67 (10.8%; 95% CI, 8.4%-13.3%) were omitted. The percentage of recommendations retained varied across guidelines from 15.4% (95% CI, 1.9%-45.4%) to 94.1% (95% CI, 80.3%-99.3%; P < .001). Among recommendations with available information on level of evidence, 90.5% (95% CI, 83.2%-95.3%) of recommendations supported by multiple randomized studies were retained, vs 81.0% (95% CI, 74.8%-86.3%) of recommendations supported by 1 randomized trial or observational data and 73.7% (95% CI, 65.8%-80.5%) of recommendations supported by opinion (P = .001). After accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was greater for recommendations based on opinion (odds ratio, 3.14; 95% CI, 1.69-5.85; P < .001) or on 1 trial or observational data (odds ratio, 3.49; 95% CI, 1.45-8.41; P = .005) vs recommendations based on multiple trials. CONCLUSIONS AND RELEVANCE: The durability of class I cardiology guideline recommendations for procedures and treatments promulgated by the ACC/AHA varied across individual guidelines and levels of evidence. Downgrades, reversals, and omissions were most common among recommendations not supported by multiple randomized studies.
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The increase in LOE B recommendations in ACC/AHA guidelines is more likely explained, at least in part, by new observational big data sources and advanced statistical methods.
“More likely, the increase in LOE B recommendations from prior to current ACC/AHA guideline documents can be explained, at least in part, by the elaboration of new observational”
From Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 (2019) · cites this paper as [104]
Comparative effectiveness analyses using observational data are limited by residual confounding.
“comparative effectiveness analyses using observational data are limited by residual confounding”
From Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 (2019) · cites this paper as [104]
In most circumstances, a well-conducted RCT is the only study design that enables a true comparison between 2 medications, procedures, or treatment strategies.
“in most circumstances a well-conducted RCT is the only study design that enables a true comparison (and causeeffect relationship assessment) between 2 medications, procedures, or treatment strategies.104”
From Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 (2019) · cites this paper as [104]
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GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305 · see citing works
2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536 · see citing works
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease
Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C., Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O’Gara, P. T., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.176857 · Cited by 8,479 · see citing works
Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E., Green, L. A., Hand, M. M., Hochman, J. S., Krumholz, H. M., Kushner, F. G., Lamas, G. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000134791.68010.fa · Cited by 8,345 · see citing works
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000041 · Cited by 7,119 · see citing works
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · JAMA · doi:10.1001/jama.282.15.1458 · Cited by 6,677 · see citing works
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
O’Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E., Chung, M. K., de Lemos, J. A., Ettinger, S. M., Fang, J. C.-T., Fesmire, F. M., Franklin, B. A., et al. (2012) · Circulation · doi:10.1161/cir.0b013e3182742cf6 · Cited by 4,763 · see citing works
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult
Hunt, S. A. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.08.022 · Cited by 4,127 · see citing works
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention
Levine, G. N., Bates, E., Blankenship, J. C., Bailey, S. R., Bittl, J. A., Cercek, B., Chambers, C. E., Ellis, S. G., Guyton, R. A., Hollenberg, S. M., et al. (2011) · Circulation · doi:10.1161/cir.0b013e31823ba622 · Cited by 3,289 · see citing works
Clinical Practice Guidelines We Can Trust
Board on Health Care Services (2011) · National Academies Press eBooks · doi:10.17226/13058 · Cited by 3,102 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805 · see citing works
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities
Epstein, A. E., DiMarco, J. P., Ellenbogen, K. A., Estes, N. A. M., Freedman, R. A., Gettes, L. S., Gillinov, A. M., Gregoratos, G., Hammill, S. C., Hayes, D. L., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.02.032 · Cited by 2,546 · see citing works
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Circulation · doi:10.1161/cir.0b013e3182776f83 · Cited by 2,411 · see citing works
WRITING COMMITTEE MEMBERS, Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M., Konstam, M. A., Mancini, D. M., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.167586 · Cited by 2,251 · see citing works
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article
Smith, S. C., Feldman, T. E., Hirshfeld, J. W., Jacobs, A. K., Kern, M. J., King, S. B., Morrison, D. A., O’Neill, W. W., Schaff, H. V., Whitlow, P. L., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.170815 · Cited by 2,212 · see citing works
Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., Newby, L. K., Piña, I. L., Roger, V. L., Shaw, L. J., et al. (2011) · Circulation · doi:10.1161/cir.0b013e31820faaf8 · Cited by 2,143 · see citing works
2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M. L., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T. B., Januzzi, J. L., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31829e8776 · Cited by 2,129 · see citing works
Smith, S. C., Allen, J. K., Blair, S. N., Bonow, R. O., Brass, L. M., Fonarow, G. C., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Krumholz, H. M., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.174516 · Cited by 2,087 · see citing works
ACC/AHA guidelines for coronary artery bypass graft surgery
Eagle, K. A., Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J. D., Gardner, T. J., Gott, J. P., Herrmann, H. C., Marlow, R. A., Nugent, W. C., et al. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00389-7 · Cited by 1,995 · see citing works
Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E., Chavey, W. E., Fesmire, F. M., Hochman, J. S., Levin, T. N., et al. (2007) · Circulation · doi:10.1161/circulationaha.107.181940 · Cited by 1,962 · see citing works
ACC/AHA guidelines for the management of patients with acute myocardial infarction
Ryan, T. J., Anderson, J. L., Antman, E. M., Braniff, B. A., Brooks, N. H., Califf, R. M., Hillis, L. D., Hiratzka, L. F., Rapaport, E., Riegel, B. J., et al. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00392-0 · Cited by 1,961 · see citing works
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
Epstein, A. E., Dimarco, J., Ellenbogen, K. A., Estes, N. A. M., Freedman, R. A., Gettes, L. S., Gillinov, A. M., Gregoratos, G., Hammill, S. C., Hayes, D. L., et al. (2008) · Circulation · doi:10.1161/circualtionaha.108.189742 · Cited by 1,768 · see citing works
Smith, S. C., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Gibbons, R. J., Grundy, S. M., Hiratzka, L. F., Jones, D. W., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318235eb4d · Cited by 1,759 · see citing works
Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., DEEDWANIA, P. C., Douglas, J. S., Ferguson, T. B., Fihn, S. D., Fraker, T. D., Gardin, J. M., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02848-6 · Cited by 1,688 · see citing works
Eagle, K. A., Berger, P. B., Calkins, H. G., CHAITMAN, B. R., Ewy, G. A., Fleischmann, K. E., Fleisher, L. A., Froehlich, J. B., Gusberg, R. J., Leppo, J. A., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01788-0 · Cited by 1,687 · see citing works
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H. G., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.09.003 · Cited by 1,419 · see citing works
Gregoratos, G., Abrams, J., Epstein, A. E., Freedman, R. A., Hayes, D. L., Hlatky, M. A., Kerber, R. E., Naccarelli, G. V., Schoenfeld, M. H., Silka, M. J., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02528-7 · Cited by 1,272 · see citing works
Guidelines for the Management of Patients With Valvular Heart Disease
Bonow, R. O., Carabello, B. A., de Leon, A. C., Edmunds, L. H., Fedderly, B. J., Freed, M. D., Gaasch, W. H., McKay, C. R., Nishimura, R. A., O’Gara, P. T., et al. (1998) · Circulation · doi:10.1161/01.cir.98.18.1949 · Cited by 1,024 · see citing works
Scientific evidence underlying the ACC/AHA clinical practice guidelines.
Tricoci, P. (2009) · JAMA · doi:10.1001/jama.2009.205 · Cited by 908 · see citing works
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Circulation · doi:10.1161/cir.0b013e318277d6a0 · Cited by 845 · see citing works
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery
Hillis, L. D., Smith, P. K., Anderson, J. L., Bittl, J. A., Bridges, C. R., Byrne, J. G., Cigarroa, J. E., DiSesa, V. J., Hiratzka, L. F., Hutter, A. M., et al. (2011) · Circulation · doi:10.1161/cir.0b013e31823c074e · Cited by 782 · see citing works
Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update
Mosca, L. J., Banka, C. L., Benjamin, E. J., Berra, K. A., Bushnell, C., Dolor, R. J., Ganiats, T. G., Gomes, A. S., Gornik, H. L., Gracia, C., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.020 · Cited by 749 · see citing works
Shekelle, P. G., Ortíz, E., Rhodes, S. L., Morton, S. C., Eccles, M., Grimshaw, J., & Woolf, S. H. (2001) · PubMed · doi:10.1001/jama.286.12.1461 · Cited by 604 · see citing works
Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. E. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · Pediatric Research · doi:10.1203/00006450-199904020-00719 · Cited by 604 · see citing works
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H. G., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., et al. (2007) · Circulation · doi:10.1161/circulationaha.107.185699 · Cited by 592 · see citing works
Fuster, V., Rydén, L., ASINGER, R. W., Cannom, D. S., Crijns, H. J. G. M., Frye, R. L., Halperin, J. L., Kay, G. N., Klein, W. W., Lévy, S., et al. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2983 · Cited by 489 · see citing works
ACC/AHA/SCAI Practice Guidelines, February 21, 2006
(2006) · Circulation · doi:10.1161/circulationaha.106.173220 · Cited by 422 · see citing works
A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices
Prasad, V., Vandross, A., Toomey, C., Cheung, M., Rho, J., Quinn, S., Chacko, S. J., Borkar, D., Gall, V., Selvaraj, S., et al. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2013.05.012 · Cited by 381 · see citing works
Spertus, J. A., Eagle, K. A., Krumholz, H. M., Mitchell, K. R., & Normand, S. T. (2005) · Circulation · doi:10.1161/01.cir.0000157096.95223.d7 · Cited by 335 · see citing works
Enhancing Physicians’ Use of Clinical Guidelines
Pronovost, P. J. (2013) · JAMA · doi:10.1001/jama.2013.281334 · Cited by 289 · see citing works
The Emergence of Clinical Practice Guidelines
Weisz, G., Cambrosio, A., Keating, P., Knaapen, L., Schlich, T., & Tournay, V. (2007) · Milbank Quarterly · doi:10.1111/j.1468-0009.2007.00505.x · Cited by 258 · see citing works
Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H. G., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.176009 · Cited by 214 · see citing works
Reversals of Established Medical Practices
Prasad, V. K., Cifu, A. S., & Ioannidis, J. P. A. (2012) · JAMA · doi:10.1001/jama.2011.1960 · Cited by 188 · see citing works
Spertus, J. A., Eagle, K. A., Krumholz, H. M., Mitchell, K. R., & Normand, S. T. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.03.011 · Cited by 161 · see citing works
Why we can't trust clinical guidelines
Lenzer, J. (2013) · BMJ · doi:10.1136/bmj.f3830 · Cited by 157 · see citing works
The Frequency of Medical Reversal
Prasad, V. K. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.295 · Cited by 137 · see citing works
Evidence-Based Guidelines As a Foundation For Performance Incentives
Garber, A. M. (2005) · Health Affairs · doi:10.1377/hlthaff.24.1.174 · Cited by 80 · see citing works
Rl, F., Jj, C., DeSanctis, R. W., Dodge, H. T., Ls, D., Fisch, C., Ls, G., Pc, G., Parsonnet, V., & Reeves, J. (1984) · PubMed · Cited by 66 · see citing works
Diaz, J. H. (2002) · Survey of Anesthesiology · doi:10.1097/00132586-200206000-00056 · Cited by 37 · see citing works
Diretrizes para o implante de marcapasso cardíaco permanente
Andrade, J. C. S., Neto, V. Á., Braile, D. M., Brofman, P. R. S., Costa, A. R. B., Costa, R., Fo, S. S. G., Gauch, P. R. A., Lucchese, F. A., Filho, M. M., et al. (2000) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2000000500009 · Cited by 29 · see citing works
Why we can’t trust clinical guidelines
(2013) · BMJ · doi:10.1136/bmj.f3998 · Cited by 13 · see citing works
Current Validity of AHRQ Clinical Practice Guidelines
Ortíz, E., Eccles, M., Grimshaw, J., & Woolf, S. H. (2002) · Cited by 6 · see citing works
Flagged first, then by citations
1 of the 53 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Murad, M. H. (2017) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2017.01.001 · Cited by 399 · see citing works
“Recommendations that depended on multiple randomized trials were less likely to change.(67) The concept of a living guideline (ie, a guideline”
BackgroundLiving systematic reviews: 4. Living guideline recommendations.
Akl, E. A., Meerpohl, J. J., Elliott, J., Kahale, L. A., Schünemann, H. J., Agoritsas, T., Hilton, J., Perron, C., Akl, E., Hodder, R., et al. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.08.009 · Cited by 328 · see citing works
Fanaroff, A. C., Califf, R. M., Windecker, S., Smith, S. C., & Lopes, R. D. (2019) · JAMA · doi:10.1001/jama.2019.1122 · Cited by 228 · see citing works
The validity of recommendations from clinical guidelines: a survival analysis
García-Domínguez, L., Sanabria, A. J., Álvarez, E. G., Trujillo‐Martín, M. M., Etxeandia‐Ikobaltzeta, I., Kotzeva, A., Comas, D. R., González, A. L., Barajas-Nava, L. A., del Campo, P. D., et al. (2014) · Canadian Medical Association Journal · doi:10.1503/cmaj.140547 · Cited by 185 · see citing works
Exploring the ethical and regulatory issues in pragmatic clinical trials
Califf, R. M., & Sugarman, J. (2015) · Clinical Trials · doi:10.1177/1740774515598334 · Cited by 191 · see citing works
“,(26) a PCT must: ‘‘(1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes.”
BackgroundWeinfurt, K. P., Hernandez, A. F., Coronado, G. D., DeBar, L., Dember, L. M., Green, B. B., Heagerty, P. J., Huang, S. S., James, K. T., Jarvik, J. G., et al. (2017) · BMC Medical Research Methodology · doi:10.1186/s12874-017-0420-7 · Cited by 183 · see citing works
Corso, E., Hind, D., Beever, D., Fuller, G., Wilson, M. J. A., Wrench, I., & Chambers, D. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1265-0 · Cited by 94 · see citing works
“However, by adopting a broad scope, we have ensured we offer decision-makers for a consensus exercise (see below) information on the widest range of potentially relevant interventions, to inform the production of durable guidelines [92].”
BackgroundCardiac computed tomography in current cardiology guidelines
Al-Mallah, M. H., Aljizeeri, A. H., Villines, T. C., Srichai, M. B., & Alsaileek, A. A. (2015) · Journal of cardiovascular computed tomography · doi:10.1016/j.jcct.2015.09.003 · Cited by 88 · see citing works
ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope
Goldberger, Z. D., Petek, B. J., Brignole, M., Shen, W.-K., Sheldon, R. S., Solbiati, M., Deharo, J.-C., Moya, A., & Hamdan, M. H. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.012 · Cited by 82 · see citing works
Tendal, B., Vogel, J. P., McDonald, S. J., Norris, S., Cumpston, M., White, H., Leder, K. S., Navarro, D. F., Cheyne, S., Chakraborty, S. P., et al. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.11.005 · Cited by 86 · see citing works
Smith, S. C., & Grundy, S. M. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.06.1159 · Cited by 64 · see citing works
“Indeed, an analysis of the durability of ACC/AHA Class I recommendations indicates that downgrades, reversals, and omissions were more likely among recommendations not supported by multiple RCTs (4).”
BackgroundVolovici, V., Steyerberg, E. W., Cnossen, M. C., Haitsma, I., Dirven, C. M. F., Maas, A. I. R., & Lingsma, H. F. (2019) · Journal of Neurotrauma · doi:10.1089/neu.2019.6474 · Cited by 59 · see citing works
“According to existing data in the literature, a recommendation underpinned by one or more RCTs would have an 81% chance of surviving in a subsequent version.(18) There were no predictors of survival of recommendations in the analysis we performed when looking either at the number of low- or highquality studies, althou…”
Makam, A. N., & Nguyen, O. K. (2017) · Circulation · doi:10.1161/circulationaha.116.022622 · Cited by 52 · see citing works
Lopez-Sendon, J. L., González‐Juanatey, J. R., Pinto, F. J., Castillo, J. J. C., Badimón, L., Dalmau, R., Torrecilla, E. G., López-Mínguez, J. R., Maceira, A. M., Pascual-Figal, D. A., et al. (2015) · Revista Española de Cardiología · doi:10.1016/j.recesp.2015.07.005 · Cited by 52 · see citing works
Cardiovascular Disease Risk Assessment and Prevention
Alagona, P., & Ahmad, T. A. (2015) · Medical Clinics of North America · doi:10.1016/j.mcna.2015.02.003 · Cited by 47 · see citing works
Sanabria, A. J., Hernandez, H. P., Ballesteros, M., Canelo‐Aybar, C., McFarlane, E., de Guzmán, E. N., Penman, K., Posso, M., Figuls, M. R. I., Selva, A., et al. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.06.018 · Cited by 36 · see citing works
Alseiari, M., Meyer, K. B., & Wong, J. B. (2015) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2015.09.016 · Cited by 34 · see citing works
García, L. M., Hernandez, H. P., Superchi, C., de Guzmán, E. N., Ballesteros, M., Ibargoyen-Roteta, N., McFarlane, E., Posso, M., Figuls, M. R. I., del Campo, R. R., et al. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.05.008 · Cited by 33 · see citing works
Shekelle, P. (2014) · JAMA · doi:10.1001/jama.2014.4950 · Cited by 30 · see citing works
“(1) When is there sufficient new evidence to “trigger” an update? (2) Once a trigger has been met, what methods can be used to expeditiously produce the update? (3) Once the update is completed, how is the information best communicated to relevant stakeholders? There is the most research evidence about how to detect t…”
MethodLearning from mistakes in clinical practice guidelines: the case of perioperative β-blockade
Neuman, M. D., Bosk, C. L., & Fleisher, L. A. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003114 · Cited by 28 · see citing works
Wu, P.-L., Nam, M.-Y., Choi, J.-H., Kirlik, A., Sha, L., & Berlin, R. B. (2017) · Journal of Medical Systems · doi:10.1007/s10916-017-0829-x · Cited by 26 · see citing works
“Our system selected the AHA (American Heart Association) guidelines as the basis to provide guidance, although AHA guidelines may be insufficiently detailed and incomplete [23].”
MethodBoriani, G., Venturelli, A., Imberti, J. F., Bonini, N., Mei, D. A., & Vitolo, M. (2023) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2023.04.020 · Cited by 25 · see citing works
“In studies focused on ACC/AHA guidelines some variability over time has been reported also for class I recommendations [87,88] but the solidity of evidence supporting a specific recommendation appears of crucial value, since recommendations supported by multiple RCTs, resulting in a LOE A were…”
Lopez-Sendon, J. L., González‐Juanatey, J. R., Pinto, F. J., Castillo, J. J. C., Badimón, L., Dalmau, R., Torrecilla, E. G., López-Mínguez, J. R., Maceira, A. M., Pascual-Figal, D. A., et al. (2015) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2015.07.003 · Cited by 24 · see citing works
Improving Clinical Practice Guidelines for Practicing Cardiologists
Benhorin, J., Bodenheimer, M., Brown, M. W., Case, R. B., Dwyer, E. M., Eberly, S. W., Francis, C. W., Gillespie, J. A., Goldstein, R. E., Greenberg, H., et al. (2015) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2015.03.026 · Cited by 23 · see citing works
Sheldrick, R. C., Hyde, J. K., Leslie, L. K., & Mackie, T. I. (2019) · Evidence & Policy · doi:10.1332/174426419x15677739896923 · Cited by 23 · see citing works
Evidence for the Universal Blood Pressure Goal of <130/80 mm Hg Is Strong
Kaul, S. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.14648 · Cited by 20 · see citing works
Current Recommendations for Perioperative Brain Health: A Scoping Review
Wooding, D. J., Field, T. S., Schwarz, S. K. W., MacDonell, S.-Y., Farmer, J. B., Rajan, S., & Flexman, A. M. (2022) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0000000000000861 · Cited by 19 · see citing works
Evidence-Based Medicine and the American Thoracic Society Clinical Practice Guidelines
Schumacher, R. C., Nguyen, O. K., Deshpande, K. S., & Makam, A. N. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.7461 · Cited by 17 · see citing works
Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee
Uhlig, K., Berns, J. S., Carville, S. F., Chan, W., Cheung, M., Guyatt, G. H., Hart, A., Lewis, S. Z., Tonelli, M. A., Webster, A. C., et al. (2016) · Kidney International · doi:10.1016/j.kint.2015.11.030 · Cited by 17 · see citing works
“[9] A study of class I cardiology recommendations by the American College of Cardiology/American Heart Association found that the time from initial publication to an updated guideline ranged from 4 to 10 years.[10] Class I recommendations are strong, definitive recommendations that something should be done.”
BackgroundØstergaard, L., Valeur, N., Bundgaard, H., Butt, J. H., Ihlemann, N., Køber, L., & Fosbøl, E. L. (2017) · American Heart Journal · doi:10.1016/j.ahj.2017.07.018 · Cited by 16 · see citing works
“In the 2005 AHA guidelines, most of the guidelines’ level of evidence A was diagnosis recommendations; however, these recommendations were only supported by a level of evidence B in the 2015 AHA guidelines and were hence downgraded.5,6 The durability of the class I recommendations from AHA and the American College of…”
MethodGarcía, L. M., Hernandez, H. P., de Guzmán, E. N., Superchi, C., Ballesteros, M., McFarlane, E., Penman, K., Posso, M., Figuls, M. R. I., Sanabria, A. J., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017226 · Cited by 15 · see citing works
Updated clinical guidelines experience major reporting limitations
Vernooij, R. W. M., García, L. M., Flórez, I. D., Armas, L. H., Poorthuis, M. H. F., Brouwers, M. C., & Alonso‐Coello, P. (2017) · Implementation Science · doi:10.1186/s13012-017-0651-3 · Cited by 15 · see citing works
Guideline on terminology and definitions of updating clinical guidelines: The Updating Glossary
García, L. M., Hernandez, H. P., Sanabria, A. J., Alonso‐Coello, P., Penman, K., McFarlane, E., García, L. M., Hernandez, H. P., Sanabria, A. J., Alonso‐Coello, P., et al. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.11.023 · Cited by 15 · see citing works
Jukema, J. W., Lettino, M., Widimský, P., Danchin, N., Bardajı́, A., Barrabés, J. A., Cequier, A. R., Claeys, M. J., Luca, L. D., Dörler, J., et al. (2015) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvv024 · Cited by 14 · see citing works
Quantity Over Quality: How the Rise in Quality Measures is Not Producing Quality Results
ESPOSITO, M. L., Selker, H. P., & Salem, D. N. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3278-6 · Cited by 14 · see citing works
“In an analysis of class I ACC/AHA guideline recommendations over a period of several years, revisions in recommendations were found most commonly among those not verified by multiple RCTs.40 Clinicians may prematurely endorse and propagate new guidelines based on Bconsensus validity,^ when the consensus process itself…”
BackgroundComparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults
Neuman, M. D., Sieber, F. E., & Dillane, D. (2023) · Anesthesiology · doi:10.1097/aln.0000000000004604 · Cited by 13 · see citing works
Kalinoski-DuBose, V., Yao, X., Dunlay, S. M., Dhruva, S. S., Ross, J. S., Shah, N. D., & Noseworthy, P. A. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.012065 · Cited by 13 · see citing works
“Our study examined all cardiology topic areas of ACC/AHA clinical practice guidelines published in the past decade, stratified by 6 topic areas ([1] arrhythmias; [2] prevention; [3] acute and stable ischemia; [4] heart failure; [5] valvular heart disease; and [6] vascular medicine) to assess changes in the”
BackgroundContinuous surveillance of a pregnancy clinical guideline: an early experience
García, L. M., Hernandez, H. P., Sanabria, A. J., & Alonso‐Coello, P. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0506-7 · Cited by 11 · see citing works
Borne, R. T., Varosy, P. D., Lan, Z., Masoudi, F. A., Curtis, J. P., Matlock, D. D., & Peterson, P. N. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.3429 · Cited by 11 · see citing works
Vetter, T. R., Hunter, J. M., & Boudreaux, A. M. (2014) · BMC Anesthesiology · doi:10.1186/1471-2253-14-73 · Cited by 10 · see citing works
“Downgrades, reversals, and omissions were most common among recommendations that were not supported by multiple randomized studies [24].”
BackgroundWynne, R. M., Omarit, R., & Crowe, S. (2025) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvaf018 · Cited by 9 · see citing works
Borne, R. T., Randolph, T. C., Wang, Y., Curtis, J. P., Peterson, P. N., Masoudi, F. A., Sandhu, A., Zipse, M. M., Thomas, K. L., Kutyifa, V., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.13553 · Cited by 9 · see citing works
Fanaroff, A. C., Fudim, M., Califf, R. M., Windecker, S., Smith, S. C., & Lópes, R. D. (2020) · American Heart Journal · doi:10.1016/j.ahj.2020.05.003 · Cited by 9 · see citing works
Dixon, D. L., Harris, I. M., Aljadeed, R., Anderson, K. C., Aycock, A., Beavers, C. J., Beckman, E. J., Isaacs, D. M., McCoy, E., Sandler, A., et al. (2022) · JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY · doi:10.1002/jac5.1743 · Cited by 7 · see citing works
“This point was confirmed in a textual analysis for 11 ACC/AHA guidelines published between 1998 and 2007 and then revised between 2006 and 2013.(30) In this analysis, after accounting for guideline-level factors, recommendations based on expert opinion, a single RCT, or observational studies were three times more like…”
MethodTahhan, A. S., Vaduganathan, M., Greene, S. J., Okafor, M. O., Kumar, S., & Butler, J. (2018) · Current Heart Failure Reports · doi:10.1007/s11897-018-0374-z · Cited by 7 · see citing works
The Current Landscape of Atrial Fibrillation and Atrial Flutter Clinical Trials
Patel, R. B., Venkateswaran, R. V., Singh, A., Bhatt, D. L., Fonarow, G. C., PASSMAN, R. S., Butler, J., Yancy, C. W., & Vaduganathan, M. (2018) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2018.04.008 · Cited by 7 · see citing works
“Although we recognize that a number of these patterns in the quality of evidence base appear common across therapeutic areas in cardiovascular medicine (15,16), we highlight important opportunities to promote application of more rigorous and homogenous trial methodology specific to AF/AFL in the future.”
BackgroundIndicator of quality for environmental articles on Wikipedia at the higher education level
Petiška, E., & Moldan, B. (2019) · Journal of Information Science · doi:10.1177/0165551519888607 · Cited by 6 · see citing works
“This is a significant problem in medicine because the most respected sources, such as medical guidelines, are being questioned by new research [39].”
BackgroundThe guideline for therapeutic drug monitoring guidelines development
Zeng, L., Yi, Q., Huang, L., Chen, W., Men, P., Zhang, J., Jiang, Z., Miao, L., Zhao, R., Zhang, X., et al. (2022) · Journal of Evidence-Based Medicine · doi:10.1111/jebm.12486 · Cited by 6 · see citing works
Stone, N. J. (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.0760 · Cited by 6 · see citing works
Petretta, M., & Cuocolo, A. (2017) · Journal of Nuclear Cardiology · doi:10.1007/s12350-017-0885-0 · Cited by 5 · see citing works
Snipelisky, D., Waldo, O. A., & Burton, M. C. (2015) · Clinical Cardiology · doi:10.1002/clc.22393 · Cited by 5 · see citing works
“4) Diuretic, 26 (52); ACEI, 24 (48); angiotensin ant, 6 (12); BB, 1 (2); CCB, 10 (20); vasodilator, 0 (0); other, 1 (2) 0.”
Vincent, C. A., & Amalberti, R. (2016) · Springer eBooks · doi:10.1007/978-3-319-25559-0_6 · Cited by 4 · see citing works
Araya, A., Zeng, J., Johnson, A. M., Shufean, M. A., Rodon, J. A., Meric‐Bernstam, F., & Bernstam, E. V. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104261 · Cited by 4 · see citing works
Volovici, V., & Steyerberg, E. W. (2021) · World Neurosurgery · doi:10.1016/j.wneu.2021.03.095 · Cited by 3 · see citing works
Training the Mind, and the Food and Drug Administration, on Droperidol
Newman, D. H. (2015) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2015.05.030 · Cited by 3 · see citing works
Faut-il continuer à faire des recommandations professionnelles de bonne pratique clinique ?
Delaunay, L., & Plantet, F. (2016) · Le Praticien en Anesthésie Réanimation · doi:10.1016/j.pratan.2016.10.009 · Cited by 3 · see citing works
Clinical Practice Guidelines in Anesthesiology: Adjusting Our Expectations
Neuman, M. D., & Apfelbaum, J. L. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003809 · Cited by 3 · see citing works
Is the Guideline Process Replicable and, if Not, What Does This Mean?
Sniderman, A. D., Furberg, C. D., Toth, P. P., & Thanassoulis, G. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.05.002 · Cited by 2 · see citing works
Promoting informed health choices: the long and winding road
Oxman, A. D., Chalmers, I., & Glasziou, P. (2025) · Journal of the Royal Society of Medicine · doi:10.1177/01410768251384317 · Cited by 2 · see citing works
Cholesterol Guidelines: More Similar Than Different
Pokharel, Y., Akeroyd, J. M., & Virani, S. S. (2016) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2016.07.010 · Cited by 2 · see citing works
Future for Systematic Reviews and Meta‐Analysis
Ebrahim, S. B. J., & Huffman, M. D. (2022) · Wiley eBooks · doi:10.1002/9781119099369.ch24 · Cited by 1 · see citing works
Indapamide: the diuretic of choice for managing blood pressure in Indian populations
Janakiraman, E., Vaidyanathan, P. R., Nagarajan, R., Tyagi, H. O., SHARMA, A. K., Garg, R., Mallesh, P., Prajapati, H. K., & Waghmare, A. (2025) · International Journal of Advances in Medicine · doi:10.18203/2349-3933.ijam20253361 · Cited by 1 · see citing works
Ethics in Research and Publication
Jackson, S. H., & Norman, G. A. V. (2015) · Springer eBooks · doi:10.1007/978-3-319-15949-2_16 · Cited by 1 · see citing works
“Recommendations arrived at prematurely can lead not only to ineffective care, but even to morbidity and/or mortality, a violation of the ethical obligation of physician benefi cence and nonmalefi cence [ 54 56 ].”
BackgroundIncorporating Clinical Expertise and The Clinical Presentation in Evidence-Based Medicine
Mitchelmore, B. R., & Banh, H. L. (2016) · Journal of Pharmaceutical Care & Health Systems · doi:10.4172/2376-0419.1000e112 · Cited by 1 · see citing works
Recent published hypertension guidelines: A critical approach
Manolis, A. J., & Kallistratos, M. S. (2019) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2019.04.005 · Cited by 1 · see citing works
Evidence-Based Medicine and the American Thoracic Society Guidelines—Reply
Schumacher, R. C., Nguyen, O. K., & Makam, A. N. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.1656 · Cited by 1 · see citing works
Filling the glass of evidence‐based medicine
Scott, I. A. (2020) · Internal Medicine Journal · doi:10.1111/imj.14697 · Cited by 1 · see citing works
2021 European guidelines on cardiovascular prevention: Challenges for an evidence‐based patient care
Gencer, B., & Tessitore, E. (2022) · European Journal of Clinical Investigation · doi:10.1111/eci.13752 · Cited by 1 · see citing works
Reducing the burden of ischemic stroke with lipid expertise
Stone, N. J., & Paranandi, K. S. (2025) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2025.12.001 · Cited by 1 · see citing works
Guidelines based on multiple randomized studies prove the most durable, US study finds
McCarthy, M. (2014) · BMJ · doi:10.1136/bmj.g3614
Miller, T. R., & Halzack, N. M. (2015) · ASA Monitor · doi:10.1097/01.asm.0001072624.79193.d8
The challenges in producing high-quality clinical evidence
Beattie, W. S. (2015) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-015-0542-5
“The ability to independently reproduce a finding is the core principle of quality of evidence.(25)”
BackgroundHow Durable Are the Strong Recommendations Made in Practice Guidelines
Krumholz, H. M., & Sm (2014) · Journal watch · doi:10.1056/nejm-jw.na34765
Low complexity system architecture design for medical Cyber-Physical-Human Systems (CPHS)
Wu, P.-L. (2016) · Illinois Digital Environment for Access to Learning and Scholarship (University of Illinois at Urbana-Champaign)
Implantable Cardioverter Defibrillators for Nonischemic Cardiomyopathy
Shah, R., Sabghi, R., & Dennis, M. (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.3259
Turning Guidelines Into Outcomes
Michel, J. (2017) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2017.11930209
“Downgrades, reversals, and omissions are most common among recommendations not supported by multiple randomized clinical trials (RCTs) (5).”
BackgroundShah, R. (2018) · Annals of Internal Medicine · doi:10.7326/l17-0690
Intraoperative and immediate postoperative management
Fischer, M., Arslan‐Carlon, V., & Melendez, J. A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-34062-5.00024-8
Costa, F., & Servadei, F. (2021) · Journal of Neurosurgical Sciences · doi:10.23736/s0390-5616.20.05039-0
The need for guidelines in everyday clinical practice: Today: Good, bad, ugly
Ostojić, M., Ilić, I., Nikolić, A., Otašević, P., Đokić, D., & Bojić, M. (2022) · Galenika Medical Journal · doi:10.5937/galmed2201112o
Lopez-Sendon, J. L., González‐Juanatey, J. R., Pinto, F. J., Castillo, J. J. C., Badimón, L., Dalmau, R., Torrecilla, E. G., López-Mínguez, J. R., Maceira, A. M., Pascual-Figal, D. A., et al. (2015) · Cirugía Cardiovascular · doi:10.1016/j.circv.2015.09.001
Commentary: Evidence-based or eminence-based surgical practice?
Blackmon, S. H., & Klompas, A. M. (2022) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2022.12.017
Navarro, A. R., Gallardo, M. D. Q., Espiñeira, C. H., Barrientos‐Trigo, S., & Pórcel‐Gálvez, A. M. (2023) · Metas de Enfermería · doi:10.35667/metasenf.2023.26.1003082043
(2016) · ASA Monitor · doi:10.1097/01.asm.0001074376.03389.be
Integrated Adaptive Microlearning System for Healthcare Professionals
Petrov, L., Kirin, S. D., & Vasojević, N. (2024) · Lecture notes in networks and systems · doi:10.1007/978-3-031-78635-8_30
Boesen, K., Klingenberg, S. L., & Gluud, C. N. (2025) · medRxiv · doi:10.1101/2025.08.11.25333132
Cao, Z., Wang, Y., Zhang, X., Zhang, L., Zeng, Z., Lin, F., Wang, H., Huang, J., Zou, C., Bi, Z. Q., et al. (2026) · Clinical and Public Health Guidelines · doi:10.1002/gin2.70068
Shuhaiber, J. H. (2026) · JTCVS Open · doi:10.1016/j.xjon.2026.101985
Caldas, A. C., Matias, D. S., Medina, D., & Correia, L. C. L. (2026) · International Journal of Cardiovascular Sciences · doi:10.36660/ijcs.20250148
- Authors
- Neuman, M. D., Goldstein, J. N., Cirullo, M. A., & Schwartz, J. S.
- Affiliations
- Leonard Davis Institute of Health Economics (US)
- University of Pennsylvania (US)
- ORCID
- Neuman, Mark D.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-05-28
- Volume
- 311
- Issue
- 20
- Pages
- 2092
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4346183
- OpenAlex
- W2133037169
- Cited by
- 89
- References
- 53
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 8 · 2021: 3 · 2020: 6 · 2019: 10 · 2018: 3 · 2017: 17 · 2016: 7 · 2015: 16 · 2014: 7
- FWCI
- 15.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K08AG043548)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- clinical practice guideline recommendations, guideline revision, level of evidence, ACC/AHA guidelines, cardiology, evidence-based medicine, observational data, expert opinion, guideline adherence, guideline appropriateness, guideline applicability
- MeSH terms
- American Heart Association, Cardiology, Humans, Societies, Medical, Time Factors, United States, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Evidence-Based Medicine
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