Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018
Open accessAbstract
Importance: Clinical decisions are ideally based on evidence generated from multiple randomized controlled trials (RCTs) evaluating clinical outcomes, but historically, few clinical guideline recommendations have been based entirely on this type of evidence. Objective: To determine the class and level of evidence (LOE) supporting current major cardiovascular society guideline recommendations, and changes in LOE over time. Data Sources: Current American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) clinical guideline documents (2008-2018), as identified on cardiovascular society websites, and immediate predecessors to these guideline documents (1999-2014), as referenced in current guideline documents. Study Selection: Comprehensive guideline documents including recommendations organized by class and LOE. Data Extraction and Synthesis: The number of recommendations and the distribution of LOE (A [supported by data from multiple RCTs or a single, large RCT], B [supported by data from observational studies or a single RCT], and C [supported by expert opinion only]) were determined for each guideline document. Main Outcomes and Measures: The proportion of guideline recommendations supported by evidence from multiple RCTs (LOE A). Results: Across 26 current ACC/AHA guidelines (2930 recommendations; median, 121 recommendations per guideline [25th-75th percentiles, 76-155]), 248 recommendations (8.5%) were classified as LOE A, 1465 (50.0%) as LOE B, and 1217 (41.5%) as LOE C. The median proportion of LOE A recommendations was 7.9% (25th-75th percentiles, 0.9%-15.2%). Across 25 current ESC guideline documents (3399 recommendations; median, 130 recommendations per guideline [25th-75th percentiles, 111-154]), 484 recommendations (14.2%) were classified as LOE A, 1053 (31.0%) as LOE B, and 1862 (54.8%) as LOE C. When comparing current guidelines with prior versions, the proportion of recommendations that were LOE A did not increase in either ACC/AHA (median, 9.0% [current] vs 11.7% [prior]) or ESC guidelines (median, 15.1% [current] vs 17.6% [prior]). Conclusions and Relevance: Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT. This pattern does not appear to have meaningfully improved from 2008 to 2018.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 11 cited sources checked · 0 supported · 0 flagged
- Findingown data
Among class I and III recommendations in current ESC guidelines, 49.6% were LOE C.
“934 (49.6%) as LOE C”
Quote in the paperNot a substantial claim - Findingown data
Among class I recommendations in current ESC guidelines, 21.5% were LOE A.
“Of 1622 class I recommendations, 349 (21.5%) were LOE A.”
Quote in the paperNot a substantial claim - Findingown data
Among class I and III recommendations in current ESC guidelines, 21.3% were LOE A.
“ESC guidelines contained 1884 class I and class III recommendations, 402 (21.3%) classified as LOE A”
Quote in the paperNot a substantial claim - Findingown data
In 26 current ACC/AHA guidelines (2930 recommendations), 8.5% of recommendations were classified as LOE A.
“Across 26 current ACC/AHA guidelines (2930 recommendations; median, 121 recommendations per guideline [25th-75th percentiles, 76-155]), 248 recommendations (8.5%) were classified as LOE A”
- Also stated in: § Results · plain
“Across the 26 current ACC/AHA guidelines, 248 recommendations (8.5%) were classified as LOE A”
- Also stated in: § Discussion · plain
“less than 10% of recommendations from current ACC/AHA guidelines”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
In 26 current ACC/AHA guidelines, 41.5% of recommendations were LOE C.
“1217 (41.5%) as LOE C”
- Also stated in: § Results · plain
“1217 (41.5%) as LOE C”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Among class I recommendations in current ACC/AHA guidelines, 14.2% were LOE A.
“Of 1272 class I recommendations, 180 (14.2%) were classified as LOE A.”
Quote in the paperNot a substantial claim - Findingown data
Among class I or III recommendations in current ACC/AHA guidelines, 12.9% were LOE A.
“Of these recommendations, 207 (12.9%) were supported by LOE A evidence”
Quote in the paperNot a substantial claim - Findingown data
The median proportion of LOE A recommendations across current ACC/AHA guidelines was 7.9% (IQR 0.9-15.2).
“The median proportion of LOE A recommendations was 7.9% (25th-75th percentiles, 0.9%-15.2%).”
- Also stated in: § Results · plain
“of which 7.9% (25th-75th percentiles, 0.9%-15.2%)were LOE A”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
In ESC guidelines, median proportion LOE B was 31.7% current vs 33.4% prior.
“the proportion of recommendations that were LOE B (median, 31.7% [current] vs 33.4% [prior])”
Quote in the paperNot a substantial claim - Findingown data
Among class I or III recommendations in current ACC/AHA guidelines, 38.2% were LOE C.
“612 (38.2%) by LOE C evidence”
Quote in the paperNot a substantial claim - Findingown data
In 25 current ESC guidelines, 54.8% were LOE C.
“1862 (54.8%) as LOE C”
- Also stated in: § Results · plain
“1862 (54.8%) as LOE C”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
In current ACC/AHA guidelines, the proportion of LOE A recommendations by subspecialty ranged from 2.0% (valvular and congenital heart disease) to 14.5% (general cardiology).
“the proportion of recommendations characterized as LOE A ranged from 2.0% (valvular and congenital heart disease) to 14.5% (general cardiology)”
Quote in the paperNot a substantial claim - Findingown data
Among class I recommendations in ESC guidelines, median proportion LOE A was 26.9% in current vs 23.6% in prior, indicating little change.
“Among class I recommendations, there was similarly little change in the proportion that were LOE A between current and prior guidelines (median, 26.9% in current vs 23.6% in prior).”
Quote in the paperSubstantial claim - Findingown data
Median proportion of LOE A in current ESC guidelines was 9.1%.
“of which 9.1% (25th-75th percentiles, 3.8%-23.1%)were LOE A”
Quote in the paperNot a substantial claim - Findingown data
Median proportion of LOE B in current ESC guidelines was 32.6%.
“32.6% (25th-75th percentiles, 20.5%-38.9%)were LOE B”
Quote in the paperNot a substantial claim - Findingown data
Among 17 topics with both current ESC and ACC/AHA guidelines, 13.3% of ESC recommendations were LOE A.
“Among these guideline documents, 13.3% of recommendations in ESC guidelines and 7.5% of recommendations in ACC/AHA guidelines were supported by LOE A evidence.”
Quote in the paperSubstantial claim - Findingown data
In ESC guidelines, median proportion LOE C was 49.3% current vs 48.0% prior.
“or LOE C (median, 49.3% [current] vs 48.0% [prior])”
Quote in the paperNot a substantial claim - Findingown data
In current ESC guidelines, proportion LOE A by subspecialty ranged from 2.5% to 25.0%.
“the proportion of recommendations characterized as LOE A ranged from 2.5% (valvular and congenital heart disease) to 25.0% (general cardiology)”
Quote in the paperNot a substantial claim - Findingown data
In ACC/AHA guidelines, median number of LOE A recommendations was 10.5 in prior vs 11.5 in current.
“The median number of LOE A recommendations in prior guidelines was 10.5 (25th-75th percentiles, 7.5-28.0)compared with 11.5 (25th-75th percentiles, 6.5-16.0) in current guidelines”
Quote in the paperNot a substantial claim - Findingown data
In 25 current ESC guidelines, 31.0% were LOE B.
“1053 (31.0%) as LOE B”
- Also stated in: § Results · plain
“1053 (31.0%) as LOE B”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
In 25 current ESC guidelines (3399 recommendations), 14.2% were LOE A.
“Across 25 current ESC guideline documents (3399 recommendations; median, 130 recommendations per guideline [25th-75th percentiles, 111-154]), 484 recommendations (14.2%) were classified as LOE A”
- Also stated in: § Results · plain
“Across the 25 current ESC guidelines, 484 recommendations (14.2%) were classified as LOE A”
- Also stated in: § Discussion · plain
“less than 15% of recommendations from current ESC guidelines”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Median proportion of LOE B in current ACC/AHA guidelines was 50.1%.
“50.1% (25th-75th percentiles, 40.9%-58.4%)were LOE B”
Quote in the paperNot a substantial claim - Findingown data
Among class I recommendations in ACC/AHA guidelines, median proportion LOE A was 16.1% in current vs 20.7% in prior, indicating no meaningful change.
“Among class I recommendations, there was similarly no meaningful change in the proportion that were LOE A between current and prior guidelines (median, 16.1% in current vs 20.7% in prior).”
Quote in the paperSubstantial claim - Findingown data
In 26 current ACC/AHA guidelines, 50.0% of recommendations were LOE B.
“1465 (50.0%) as LOE B”
- Also stated in: § Results · plain
“1465 (50.0%) as LOE B”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
Median proportion of LOE C in current ACC/AHA guidelines was 38.4%.
“38.4% (25th-75th percentiles, 31.2%-49.0%)were LOE C”
Quote in the paperNot a substantial claim - Findingown data
Among class I and III recommendations in current ESC guidelines, 29.1% were LOE B.
“548 (29.1%) as LOE B”
Quote in the paperNot a substantial claim - Findingown data
In ACC/AHA guidelines, median proportion of LOE B increased from 41.9% in prior to 51.0% in current.
“the proportion of LOE B recommendations increased (median, 41.9% vs 51.0%)”
Quote in the paperSubstantial claim - Findingown data
In 8 ACC/AHA guidelines published since 2015, 26.5% of LOE B recommendations were based on RCT data.
“there were a total of 543 recommendations with LOE B, and 144 of these recommendations (26.5%) were based on data from RCTs.”
Quote in the paperSubstantial claim - Findingown data
In 10 of 16 ACC/AHA current/prior guideline dyads, there were more LOE A recommendations in the prior iteration.
“in 10 of 16 current/prior guideline dyads, there were more LOE A recommendations in the prior iteration of the guidelines.”
Quote in the paperSubstantial claim - Findingown data
In ACC/AHA guidelines, 5.7% of recommendations released in 2017-2018 were LOE A vs 9.5% released earlier.
“In ACC/AHA guidelines, 5.7% of recommendations released in the past 2 years were supported by LOE A evidence compared with 9.5% of recommendations released earlier”
Quote in the paperSubstantial claim - Findingown data
Among class I or III recommendations in current ACC/AHA guidelines, 48.9% were LOE B.
“785 (48.9%) by LOE B evidence”
Quote in the paperNot a substantial claim - Findingown data
Median proportion of LOE C in current ESC guidelines was 50.0%.
“50.0%(25th-75th percentiles, 40.3%-72.7%)were LOE C”
Quote in the paperNot a substantial claim - Findingown data
In ESC guidelines, 17.4% of recommendations released in 2017-2018 were LOE A vs 12.8% released earlier.
“In ESC guidelines, 17.4% of recommendations released in the past 2 years were supported by LOE A evidence, compared with 12.8% of recommendations released earlier.”
Quote in the paperSubstantial claim - Findingown data
In ACC/AHA guidelines, median proportion of LOE C decreased from 51.9% in prior to 36.7% in current.
“the proportion of LOE C recommendations decreased (median, 51.9% vs 36.7%)”
Quote in the paperSubstantial claim - Findingown data
ESC guidelines had a greater proportion of LOE A recommendations than ACC/AHA in every subspecialty except valvular and congenital heart disease.
“ESC guidelines included a greater proportion of recommendations classified as LOE A in every subspecialty area except valvular and congenital heart disease”
Quote in the paperSubstantial claim - Findingown data
A greater proportion of recommendations in ESC guidelines were classified as LOE A compared with ACC/AHA, despite using similar evidence.
“Although the ESC and ACC/AHA guidelines use similar evidence to generate recommendations, a greater proportion of recommendations overall in the ESC guidelines were classified as LOE A”
Quote in the paperSubstantial claim- Rests on an assumption: The LOE categories are comparable across ACC/AHA and ESC guidelines.
- Findingown data
Among these 17 topics, 7.5% of ACC/AHA recommendations were LOE A.
“Among these guideline documents, 13.3% of recommendations in ESC guidelines and 7.5% of recommendations in ACC/AHA guidelines were supported by LOE A evidence.”
Quote in the paperSubstantial claim - Findingown data
The absolute number of LOE A recommendations did not meaningfully change from prior to current guideline iterations.
“the absolute number of LOE A recommendations did not meaningfully change from prior to current guideline iterations.”
Quote in the paperSubstantial claim - Findingown data
A greater proportion of recommendations in ESC guidelines, both current and prior, were class I, LOE A than in ACC/AHA guidelines.
“A greater proportion of recommendations in ESC guidelines, both current and prior, were class I, LOE A than in ACC/AHA guidelines”
Quote in the paperSubstantial claim - Findingown data
In 13 of 17 topics, the ESC guideline had a greater proportion of LOE A recommendations than the ACC/AHA guideline.
“In 13 cases, the ESC guideline document had a greater proportion of recommendations supported by LOE A evidence.”
Quote in the paperSubstantial claim - Interpretationown data
Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT.
“Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT.”
- Also stated in: § Conclusions · plain
“Among recommendations in major cardiovascular society guidelines, only a small percentage were supported by evidence from multiple RCTs or a single, large RCT.”
Quote in the paperSubstantial claim- Rests on an assumption: The ACC/AHA and ESC guidelines are the major cardiovascular society guidelines.
- Rests on an assumption: The included guideline documents are representative of the evidence base for cardiovascular medicine.
- Also stated in: § Conclusions · plain
- Premisecitation
In a 2009 review of ACC/AHA guidelines, 11% of recommendations were classified as LOE A.
“In a review of the ACC/AHA clinical practice guidelines from 2009, only 11% of recommendations were classified as LOE A. 5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] source
Not checked in the free run.
- Interpretationown data
This pattern does not appear to have meaningfully improved from 2008 to 2018.
“This pattern does not appear to have meaningfully improved from 2008 to 2018.”
- Also stated in: § Conclusions · hedged
“This pattern does not appear to have meaningfully improved from 2008 to 2018.”
Quote in the paperSubstantial claim- Rests on an assumption: The included guideline documents are representative of the evidence base for cardiovascular medicine.
- Also stated in: § Conclusions · hedged
- Interpretationown data
Approximately 80% of strong (class I or III) recommendations were not LOE A.
“approximately 80% of strong (class I or III) recommendations were not characterized as LOE A”
Quote in the paperSubstantial claim - Interpretationown data
In both ACC/AHA and ESC guidelines, the large majority of patient care recommendations were based on nonrandomized evidence, including class I and III.
“In both the ACC/AHA and the ESC guidelines, the large majority of patient care recommendations were based on nonrandomized evidence, even class I (”
Quote in the paperSubstantial claim - Premisecitation
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”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [104] source
Not checked in the free run.
- Interpretationown data
Despite efforts, the proportion of guideline recommendations supported by high-quality evidence did not increase.
“The present study shows that, despite these efforts, the proportion of guideline recommendations supported by high-quality evidence did not increase.”
Quote in the paperSubstantial claim - Premisecitation
Comparative effectiveness analyses using observational data are limited by residual confounding.
“comparative effectiveness analyses using observational data are limited by residual confounding”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [104] source
Not checked in the free run.
- Premisecitation
Less than 10% of recommendations supported by higher-quality evidence were downgraded or reversed.
“compared with less than 10% of recommendations supported by higher-quality evidence.105”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [105] source
Not checked in the free run.
- Interpretationcitation
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”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [104] source
Not checked in the free run.
- Interpretationown data
Among updated guideline documents, there was no meaningful change in proportion or number of LOE A recommendations from prior to current.
“Among guideline documents that have been updated, there was no meaningful change in the proportion or number of recommendations characterized as LOE A from prior to current guidelines.”
Quote in the paperSubstantial claim- Rests on an assumption: The included guideline documents are representative of the evidence base for cardiovascular medicine.
- Interpretationown data
When comparing current and prior guidelines on the same topic, there was no meaningful increase in LOE A recommendations in either ACC/AHA or ESC.
“When directly comparing current guideline documents with prior documents covering the same topic there was similarly not a meaningful increase in recommendations with LOE A classification from the prior version to the current version of guidelines in either the ACC/AHA or ESC guidelines.”
Quote in the paperSubstantial claim - Premisecitation
The decline in cardiovascular mortality has decelerated over the past several years.
“The decline in cardiovascular mortality has decelerated over the past several years.107”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [107]
Not checked in the free run.
- Interpretationown data
Efforts over the past decade to simplify and facilitate clinical trials have not yet translated into an evidence base better supported by RCTs.
“Taken together, these results demonstrate that efforts over the past decade to simplify and facilitate clinical trials have not yet translated into an evidence base better supported by RCTs.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The proportion of guideline recommendations supported by LOE A evidence may not be a perfect surrogate for the totality of evidence.
“the proportion of guideline recommendations supported by LOE A evidence may not be a perfect surrogate for the totality of evidence”
Quote in the paperSubstantial claim - Premisecitation
Across other medical and surgical subspecialties, very few guideline recommendations were supported by high-quality evidence from multiple RCTs.
“Overall, very few recommendations were supported by high-quality evidence from multiple RCTs.[89][90][91][92][93][94][95][96][97][98][99]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [89][90][91][92][93][94][95][96][97][98][99]
Not checked in the free run.
- May combine two claims. 8
- Classified as probably not a substantial claim. 13
May combine two claims.
Findingown dataAmong ESC guidelines with prior versions, the median proportion of LOE A recommendations was 15.1% in current vs 17.6% in prior, indicating no increase.
“or ESC guidelines (median, 15.1% [current] vs 17.6% [prior])”
- Also stated in: § ESC Guidelines · plain
“the median proportion of LOE A recommendations was 15.1% (25th-75th percentiles, 3.7%-26.4%);the median proportion of LOE A recommendations among prior guidelines was 17.6% (25th-75th percentiles, 2.4%-27.6%)”
Quote in the paperSubstantial claim- Also stated in: § ESC Guidelines · plain
May combine two claims.
Findingown dataAmong ACC/AHA guidelines with prior versions, the median proportion of LOE A recommendations was 9.0% in current vs 11.7% in prior, indicating no increase.
“the proportion of recommendations that were LOE A did not increase in either ACC/AHA (median, 9.0% [current] vs 11.7% [prior])”
- Also stated in: § Changes From Prior to Current Guidelines ACC/AHA Guidelines · plain
“the median proportion of LOE A recommendations was 9.0% (25th-75th percentiles, 4.8%-15.1%);the median proportion of LOE A recommendations in prior guidelines was 11.7% (25th-75th percentiles, 5.8%-17.5%)”
Quote in the paperSubstantial claim- Also stated in: § Changes From Prior to Current Guidelines ACC/AHA Guidelines · plain
May combine two claims.
Findingown dataThere was wide variety by subject area; some guideline documents had >33% LOE A, others had none.
“there was wide variety by subject area-in some guideline documents, more than 33% of recommendations were characterized as LOE A, but others had no LOE A recommendations at all.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSome steps to improve clinical trial efficiency and funding have been taken in the intervening years.
“In the intervening years, some of these steps have been taken, [6][7][8]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6][7][8]
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataRecommendations were abstracted by a single reviewer and validated by another reviewer.
“recommendations were abstracted by a single reviewer (A.C.F.) and validated by another reviewer (R.D.L).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningAbstraction involved simple reporting and did not require judgment.
“Abstraction therefore involved simple reporting of the content of each document and did not require judgment on the part of the abstractors.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningExclusion of focused updates may lead to underestimation of the proportion of LOE A recommendations.
“exclusion of focused updates, which are usually undertaken when new RCT evidence is generated, may lead to underestimation of the proportion of LOE A recommenda-tions”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenStandards for LOE A designation may have changed over time.
“Alternatively, standards for LOE A designation may have changed over time.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Study design and conductnone givenThis limitation should not affect findings regarding changes in LOE over time.
“however, this limitation should not affect findings regarding changes in LOE over time.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenThe evidence supporting major society guideline recommendations is a surrogate for the totality of evidence in cardiology, not a direct measurement.
“First, the evidence supporting major society guideline recommendations is a surrogate for the totality of the evidence in cardiology, rather than a direct measurement.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe increase in LOE B recommendations could indicate that the proportion supported by randomized evidence is increasing.
“this increase in LOE B recommendations could indicate that the proportion of recommendations supported by randomized evidence is increasing”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIn 2009, Tricoci et al found that 12% of ACC/AHA guideline recommendations were LOE A, including 19% of class I recommendations.
“At that time, 12% of guideline recommendations were classified as LOE A, including 19% of class I recommendations.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn 6 guideline documents, Tricoci et al found minimal increases in LOE A recommendations compared with LOE B and C.
“in these 6 guideline documents, they found minimal increases in LOE A recommendations compared with LOE B and C.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] source
Not checked in the free run.
May combine two claims.
Interpretationown dataVariability among subspecialties compounded the lack of RCT evidence; some subspecialty guidelines contained almost no LOE A recommendations.
“The lack of RCT evidence supporting most recommendations in the guidelines was compounded by variability among subspecialties within cardiovascular medicine; some subspecialty guidelines contained almost no LOE A recommendations.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThis review describes only evidence supporting cardiology guidelines, not across medical and surgical subspecialties.
“Third, this review describes only evidence supporting cardiology guidelines, rather than across medical and surgical subspecialties”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenThe quality of evidence supporting each recommendation was not independently assessed.
“The quality of evidence supporting each recommendation was not independently assessed”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationSolid RCT evidence delineates treatments and strategies that lead to better patient outcomes, which can then be implemented in clinical practice.
“Solid RCT evidence delineates treatments and strategies that lead to better patient outcomes, which can then be implemented in clinical practice.106”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [106] source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
InterpretationreasoningThe high global prevalence of cardiovascular disease suggests that efforts to build a higher-quality cardiovascular medicine evidence base might have a large effect on global health.
“the high global prevalence of cardiovascular disease suggests that efforts to build a higher-quality cardiovascular medicine evidence base might have a large effect on global health.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The ACC/AHA and ESC guidelines are the major cardiovascular society guidelines.
“major cardiovascular society guideline recommendations”
The paper relies on this without support.
The LOE categories are comparable across ACC/AHA and ESC guidelines.
“Although the ESC and ACC/AHA guidelines use similar evidence to generate recommendations”
The paper relies on this without support.
The included guideline documents are representative of the evidence base for cardiovascular medicine.
“Only comprehensive guideline documents were included in this systematic review”
The paper relies on this without support.
The websites used to identify guidelines listed all current guidelines as of February 1, 2019.
“Current ACC/AHA guidelines were identified as those posted on the ACC (https://www.acc.org/guidelines#doctype= Guidelines) and ESC (https://www.escardio.org/Guidelines/ Clinical-Practice-Guidelines) websites as of February 1, 2019.”
The paper relies on this without support.
The prior guideline documents identified are the immediate predecessors covering the same topic.
“Current guidelines were also reviewed to identify references to a previous iteration of the same guideline”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Clinical trials often lack generalizability to complex patients who often fail to qualify for trials.
“First, clinical trials often lack generalizability 4 to complex patients who often fail to qualify for trials.5,6”
From Answering real-world clinical questions using large language model, retrieval-augmented generation, and agentic systems (2025) · cites this paper as [5]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
The same earlier review is assigned two LOE A percentages
MinorThe introduction attributes an 11% LOE A figure to the 2009 ACC/AHA guideline review, while the discussion attributes 12% to that same cited review.
“In a review of the ACC/AHA clinical practice guidelines from 2009, only 11% of recommendations were classified as LOE A. 5”
“In 2009, Tricoci et al 5 analyzed data from ACC/AHA guidelines published from 1984 to 2008.At that time, 12% of guideline recommendations were classified as LOE A”
Cites
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O. D., et al. (2021) · PubMed · doi:10.1093/eurheartj/ehab670 · Cited by 19,618 · see citing works
2013 ESH/ESC Guidelines for the management of arterial hypertension
Authors Task Force Members, Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht151 · Cited by 13,638 · see citing works
Self-citation2013 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
Ahmed, A., Jorna, T., & Bhandari, S. (2016) · The Nephron journals/Nephron journals · doi:10.1159/000447068 · Cited by 11,782 · see citing works
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429 · see citing works
Self-citation2018 ESC/ESH Guidelines for the management of arterial hypertension
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy339 · Cited by 10,286 · see citing works
Self-citationIbanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehx393 · Cited by 9,728 · see citing works
Self-citationEuropean Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
Self-citationACC/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
Self-citationRoffi, M., Patrono, C., Collet, J.-P., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J. J., Borger, M. A., Brotons, C., Chew, D. P., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehv320 · Cited by 8,261 · see citing works
Self-citation2018 ESC/EACTS guidelines on myocardial revascularization
Neumann, F.-J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J.-P., Falk, V., Head, S. J., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehy394 · Cited by 7,167 · see citing works
Self-citation2014 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
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437738.63853.7a · Cited by 7,081 · see citing works
Self-citation2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
Galiè, N., Humbert, M., Vachiery, J.-L., Gibbs, S., Lang, I., Torbicki, A., Simonneau, G., Peacock, A., Vonk Noordegraaf, A., Beghetti, M., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehv317 · Cited by 6,931 · see citing works
Self-citationESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
Authors/Task Force Members, McMurray, J. J. V., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs104 · Cited by 6,879 · see citing works
Self-citationAuthors Task Force Members, Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., Borger, M. A., Mario, C. D., Dickstein, K., Ducrocq, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs215 · Cited by 6,838 · see citing works
Self-citationWhelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.11.006 · Cited by 6,616 · see citing works
Self-citation2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2017 ESC/EACTS Guidelines for the management of valvular heart disease
Baumgartner, H., Falk, V., Bax, J. J., Bonis, M. D., Hamm, C. W., Holm, P. J., Iung, B., Lancellotti, P., Lansac, E., Muñoz, D. R., et al. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx391 · Cited by 6,273 · see citing works
Self-citationGrundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000625 · Cited by 6,185 · see citing works
Self-citation2015 ESC Guidelines for the management of infective endocarditis
Habib, G., Lancellotti, P., Antunes, M. J., Bongiorni, M. G., Casalta, J., Zotti, F. D., Dulgheru, R., Khoury, G. A. E., Erba, P. A., Iung, B., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv319 · Cited by 5,014 · see citing works
Self-citation2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk
Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D’Agostino, R. B., Gibbons, R., Greenland, P., Lackland, D. T., Levy, D., O’Donnell, C. J., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.005 · Cited by 4,945 · see citing works
Self-citation2013 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
2013 ESC guidelines on the management of stable coronary artery disease
Task Force Members, Montalescot, G., Sechtem, U., Achenbach, S., Andreotti, F., Arden, C., Budaj, A., Bugiardini, R., Crea, F., Cuisset, T., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht296 · Cited by 4,510 · see citing works
Self-citationErbel (2014) · doi:10.1093/eurheartj/ehu281 · Cited by 4,451 · see citing works
Self-citationGuyatt, G. H. (1992) · JAMA · doi:10.1001/jama.1992.03490170092032 · Cited by 4,447 · see citing works
2014 ESC/EACTS Guidelines on myocardial revascularization
Authors Task Force Members, Windecker, S., Kolh, P., Alfonso, F., Collet, J., Cremer, J., Falk, V., Filippatos, G., Hamm, C. W., Head, S. J., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu278 · Cited by 4,340 · see citing works
Self-citation2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy
Authors/Task Force members, Elliott, P. M., Anastasakis, A., Borger, M. A., Borggrefe, M., Cecchi, F., Charron, P., Hagege, A. A., Lafont, A., Limongelli, G., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu284 · Cited by 4,332 · see citing works
Self-citation2014 ESC/EACTS Guidelines on myocardial revascularization
Kolh, P. H., Windecker, S., Alfonso, F., Collet, J., Cremer, J., Falk, V., Filippatos, G. S., Hamm, C. W., Head, S. J., Jüni, P., et al. (2014) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezu366 · Cited by 4,211 · see citing works
Self-citationACC/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
2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., Hu, F. B., Hubbard, V. S., Jakicic, J. M., Kushner, R. F., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.004 · Cited by 4,058 · see citing works
Priori, S. G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., Elliott, P. M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv316 · Cited by 3,893 · see citing works
Self-citationStone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.002 · Cited by 3,845 · see citing works
Self-citationGuidelines for the diagnosis and treatment of pulmonary hypertension
Galiè, N., Hoeper, M. M., Humbert, M. J. C., Torbicki, A., Vachiéry, J., Barberà, J. A., Beghetti, M., Corris, P. A., Gaine, S., Gibbs, J. S. R., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp297 · Cited by 3,841 · see citing works
European guidelines on cardiovascular disease prevention in clinical practice: executive summary
Graham, I., Atar, D., Borch‐Johnsen, K., Boysen, G., Burell, G. K., Cífková, R., Dallongeville, J., Backer, G. D., Ebrahim, S. B. J., Gjelsvik, B., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm316 · Cited by 3,840 · see citing works
Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., Hiratzka, L. F., Murphy, W. R. C., Olin, J. W., Puschett, J. B., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.174526 · Cited by 3,708 · see citing works
Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D’Agostino, R. B., Gibbons, R., Greenland, P., Lackland, D. T., Levy, D., O’Donnell, C. J., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437741.48606.98 · Cited by 3,697 · see citing works
Self-citation2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes
Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.09.017 · Cited by 3,595 · see citing works
Guidelines on the management of valvular heart disease (version 2012)
Authors/Task Force Members, Vahanian, A., Alfieri, O., Andreotti, F., Antunes, M. J., Barón-Esquivias, G., Baumgartner, H., Borger, M. A., Carrel, T. P., De Bonis, M., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs109 · Cited by 3,559 · see citing works
Self-citationESC/EAS Guidelines for the management of dyslipidaemias
Reiner, Ž., Catapano, A. L., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr158 · Cited by 3,549 · see citing works
Self-citation2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.02.536 · Cited by 3,523 · see citing works
Aboyans, V., Ricco, J.-B., Bartelink, M.-L. E. L., Björck, M., Brodmann, M., Cohnert, T., Collet, J.-P., Czerny, M., De Carlo, M., Debus, S., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehx095 · Cited by 3,293 · see citing works
Self-citation2011 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 3,290 · see citing works
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw272 · Cited by 3,162 · see citing works
Self-citation2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
Authors/Task Force Members, Konstantinides, S. V., Torbicki, A., Agnelli, G., Danchin, N., Fitzmaurice, D., Galiè, N., Gibbs, J. S. R., Huisman, M. V., Humbert, M., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu283 · Cited by 3,128 · see citing works
Self-citationAuthors Task Force Members, Hamm, C. W., Bassand, J., Agewall, S., Bax, J. J., Boersma, E. H., Bueno, H., Caso, P., Dudek, D., Gielen, S., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr236 · Cited by 3,069 · see citing works
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000031 · Cited by 2,906 · see citing works
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
Authors Task Force Members, Brignole, M., Auricchio, A., Barón‐Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., Cleland, J. G. F., Deharo, J.-C., Delgado, V., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht150 · Cited by 2,824 · see citing works
Self-citationThe Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal
Gentry, J. L., Phelan, D. M. J., Desai, M. Y., & Griffin, B. P. (2017) · Cardiology · doi:10.1159/000460274 · Cited by 2,739 · see citing works
2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., Hu, F. B., Hubbard, V. S., Jakicic, J. M., Kushner, R. F., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437739.71477.ee · Cited by 2,735 · see citing works
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.003 · Cited by 2,691 · see citing works
Self-citationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012
Authors/Task Force Members, McMurray, J. J. V., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., et al. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfs105 · Cited by 2,644 · see citing works
Self-citation2015 ESC Guidelines for the diagnosis and management of pericardial diseases
Adler, Y., Charron, P., Imazio, M., Badano, L. P., Barón‐Esquivias, G., Bogaert, J. G., Brucato, A. L., Guéret, P., Klingel, K., Lionis, C. D., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv318 · Cited by 2,635 · see citing works
Self-citation2013 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., Fesmire, F. M., Franklin, B. A., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.11.019 · Cited by 2,625 · 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
Universal Definition of Myocardial Infarction: Clinical Insights
Paiva, L., Providencia, R. A., Barra, S., Dinis, P., Faustino, C., & Gonçalves, L. M. M. (2015) · Cardiology · doi:10.1159/000371739 · Cited by 2,513 · 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
Self-citationESC Guidelines for the management of grown-up congenital heart disease (new version 2010)
Endorsed by the Association for European Paediatric Cardiology (AEPC), Authors/Task Force Members, Baumgartner, H., Bonhoeffer, P., De Groot, N. M. S., de Haan, F., Deanfield, J. E., Galie, N., Gatzoulis, M. A., Gohlke-Baerwolf, C., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq249 · Cited by 2,331 · see citing works
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy
Regitz-Zagrosek, V., Roos-Hesselink, J. W., Bauersachs, J., Blomström-Lundqvist, C., Cífková, R., De Bonis, M., Iung, B., Johnson, M. R., Kintscher, U., Kranke, P., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy340 · Cited by 2,292 · see citing works
Self-citationEckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Miller, N. H., Hubbard, V. S., Lee, I.-M., Lichtenstein, A. H., Loria, C. M., Millen, B. E., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437740.48606.d1 · Cited by 2,261 · see citing works
Self-citationWRITING 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
Self-citationACC/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
Self-citation2011 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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.007 · Cited by 2,166 · 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
Self-citation2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy
Gersh, B. J., Maron, B. J., Bonow, R. O., Dearani, J. A., Fifer, M. A., Link, M. S., Naidu, S. S., Nishimura, R. A., Ommen, S. R., Rakowski, H., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318223e2bd · Cited by 2,105 · see citing works
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009)
Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and by the International Society of Chemotherapy (ISC) for Infection and Cancer, Habib, G., Hoen, B., Tornos, P., Thuny, F., Prendergast, B., Vilacosta, I., Moreillon, P., de Jesus Antunes, M., Thilen, U., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp285 · Cited by 2,014 · 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
Self-citation2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., et al. (2010) · Circulation · doi:10.1161/cir.0b013e3182051b4c · Cited by 1,968 · see citing works
Self-citationAnderson, 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
Self-citationAuthors Task Force Members, Rydén, L., Grant, P. J., Anker, S. D., Berne, C., Cosentino, F., Danchin, N., Deaton, C., Escaned, J., Hammes, H., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht108 · Cited by 1,958 · see citing works
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Self-citation2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease
Gerhard-Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman, D. E., Fleisher, L. A., Fowkes, F. G. R., Hamburg, N. M., Kinlay, S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.11.007 · Cited by 1,941 · see citing works
ESC Guidelines on the management of cardiovascular diseases during pregnancy
Endorsed by the European Society of Gynecology (ESG), T. A. F. E. P. C. (., Authors/Task Force Members, Regitz-Zagrosek, V., Blomstrom Lundqvist, C., Borghi, C., Cifkova, R., Ferreira, R., Foidart, J.-M., Gibbs, J. S. R., Gohlke-Baerwolf, C., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr218 · Cited by 1,924 · see citing works
Self-citationAl‐Khatib, S. M., Stevenson, W. G., Ackerman, M. J., Bryant, W. J., Callans, D. J., Curtis, A. B., Deal, B. J., Dickfeld, T. M., Field, M. E., Fonarow, G. C., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.10.054 · Cited by 1,883 · see citing works
Fleisher, L. A., Fleischmann, K. E., Auerbach, A. D., Barnason, S. A., Beckman, J. A., Bozkurt, B., Dávila‐Román, V. G., Gerhard‐Herman, M. D., Holly, T. A., Kane, G. C., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000106 · Cited by 1,828 · 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
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.05.021 · Cited by 1,694 · see citing works
Self-citationHiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey, D. E., Eagle, K. A., Hermann, L. K., Isselbacher, E. M., Kazerooni, E. A., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.02.015 · Cited by 1,693 · see citing works
Authors Task Force Members, Priori, S. G., Blomström‐Lundqvist, C., Mazzanti, A., Blom, N. A., Borggrefe, M., Camm, J. A., Elliot, P. M., Fitzsimons, D., Hatala, R., et al. (2015) · EP Europace · doi:10.1093/europace/euv319 · Cited by 1,667 · see citing works
2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management
Authors Task Force Members, Kristensen, S. D., Knuuti, J., Saraste, A., Anker, S. D., Bøtker, H. E., Hert, S. D., Ford, I., González‐Juanatey, J. R., Görenek, B., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu282 · Cited by 1,650 · see citing works
Self-citationStout, K. K., Daniels, C. J., Aboulhosn, J. A., Bozkurt, B., Broberg, C. S., Colman, J. M., Crumb, S. R., Dearani, J. A., Fuller, S., Gurvitz, M., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000603 · Cited by 1,602 · see citing works
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.08.018 · Cited by 1,582 · 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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.07.013 · Cited by 1,560 · see citing works
Self-citationACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
Warnes, C. A., Williams, R. G., Bashore, T. M., CHILD, J. S., Connolly, H. M., Dearani, J. A., del Nido, P. J., Fasules, J. W., Graham, T. P., Hijazi, Z. M., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.10.001 · Cited by 1,536 · see citing works
ESC Guidelines on the diagnosis and treatment of peripheral artery diseases
Endorsed by: the European Stroke Organisation (ESO), Authors/Task Force Members, Tendera, M., Aboyans, V., Bartelink, M.-L., Baumgartner, I., Clément, D., Collet, J.-P., Cremonesi, A., De Carlo, M., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr211 · Cited by 1,506 · see citing works
Self-citationAnderson, 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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.013 · Cited by 1,498 · see citing works
Self-citationACC/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
Self-citation2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
Konstantinides, S., Torbicki, A., Agnelli, G., Danchin, N., Fitzmaurice, D. A., Galiè, N., Gibbs, J. S. R., Huisman, M., Humbert, M. J. C., Kucher, N., et al. (2014) · Kardiologia Polska · doi:10.5603/kp.2014.0211 · Cited by 1,343 · see citing works
Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary
Maisch, B., Seferovic', P. M., Ristić, A. D., Erbel, R. M., Rienmüller, R., Adler, Y., Tomkowski, W. Z., Thiene, G., Yacoub, M. H., Priori, S. G., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.02.002 · Cited by 1,341 · see citing works
Fleisher, L. A., Fleischmann, K. E., Auerbach, A. D., Barnason, S. A., Beckman, J. A., Bozkurt, B., Dávila‐Román, V. G., Gerhard‐Herman, M. D., Holly, T. A., Kane, G. C., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.07.944 · Cited by 1,323 · see citing works
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.001 · Cited by 1,322 · see citing works
Self-citationACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.07.014 · Cited by 1,312 · see citing works
Self-citation2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy
Gersh, B. J., Maron, B. J., Bonow, R. O., Dearani, J. A., Fifer, M. A., Link, M. S., Naidu, S. S., Nishimura, R. A., Ommen, S. R., Rakowski, H., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.06.011 · Cited by 1,276 · 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
Self-citation‘Ten commandments’ for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization
Neumann, F., & Sousa‐Uva, M. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehy855 · Cited by 1,202 · see citing works
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Houston Miller, N., Hubbard, V. S., Lee, I.-M., Lichtenstein, A. H., Loria, C. M., Millen, B. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.003 · Cited by 1,160 · see citing works
Self-citationFuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.07.009 · Cited by 1,157 · see citing works
2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease
Stout, K., Daniels, C. J., Aboulhosn, J., Bozkurt, B., Broberg, C. S., Colman, J. M., Crumb, S. R., Dearani, J. A., Fuller, S., Gurvitz, M. Z., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.08.1029 · Cited by 1,115 · see citing works
Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.178233 · Cited by 1,080 · see citing works
Hamm, C. W., Bassand, J., Agewall, S., Bax, J. J., Boersma, E. H., Bueno, H., Caso, P., Dudek, D., Gielen, S., Huber, K., et al. (2012) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2011.11.006 · Cited by 1,061 · see citing works
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008 · see citing works
Blomstrom-Lundqvist (2003) · doi:10.1161/01.cir.0000091380.04100.84 · Cited by 955 · see citing works
Self-citationScientific 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
Self-citation2011 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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.009 · Cited by 819 · see citing works
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update
Mosca, L. J., Benjamin, E. J., Berra, K. A., 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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.02.005 · Cited by 783 · see citing works
Self-citationEvidence-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
Self-citationZipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., CHAITMAN, B. R., FROMER, M. A., Gregoratos, G., Klein, G. J., Moss, A. J., Myerburg, R. J., et al. (2006) · EP Europace · doi:10.1093/europace/eul108 · Cited by 735 · see citing works
Self-citationESC/EAS Guidelines for the management of dyslipidaemias
Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.028 · Cited by 706 · see citing works
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Perk, J., Backer, G. D., Gohlke, H., Graham, I. M., Reiner, Ž., Verschuren, W. M. M., Albus, C., Benlian, P., Boysen, G., Cífková, R., et al. (2012) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2012.05.007 · Cited by 693 · see citing works
Blomström‐Lundqvist, C., Scheinman, M. M., Aliot, E., Alpert, J. S., Calkins, H. G., Camm, A. J., Campbell, W. B., Haines, D. E., Kück, K., Lerman, B. B., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.08.013 · Cited by 681 · see citing works
Self-citationGibbons, R. J., Chatterjee, K., Daley, J., Douglas, J. S., Fihn, S. D., Gardin, J. M., Grunwald, M. A., Levy, D. A., Lytle, B. W., O’Rourke, R. A., et al. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00150-3 · Cited by 633 · see citing works
Self-citationRydén, L., Grant, P. J., Anker, S. D., Berne, C., Cosentino, F., Danchin, N., Deaton, C., Escaned, J., Hammes, H., Huikuri, H., et al. (2014) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2013.10.013 · Cited by 609 · see citing works
Self-citationPage, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000311 · Cited by 595 · 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) · Circulation · doi:10.1161/circulationaha.107.181546 · Cited by 579 · see citing works
Self-citationRecent trends in cardiovascular mortality in the United States and public health goals.
Sidney, S., Quesenberry, C. P., Jaffe, M. G., Sorel, M., Nguyen-Huynh, M. N., Kushi, L. H., Go, A. S., & Rana, J. S. (2016) · JAMA Cardiology · doi:10.1001/jamacardio.2016.1326 · Cited by 569 · see citing works
Ibáñez, B., James, S. K., Agewall, S., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0041 · Cited by 553 · see citing works
Stout, K., Daniels, C. J., Aboulhosn, J., Bozkurt, B., Broberg, C. S., Colman, J. M., Crumb, S. R., Dearani, J. A., Fuller, S., Gurvitz, M. Z., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000602 · Cited by 536 · see citing works
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention
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. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.12.001 · Cited by 527 · see citing works
Self-citation2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
Galiè, N., Humbert, M. J. C., Vachiéry, J., Gibbs, S., Lang, I. M., Torbicki, A., Simonneau, G., Peacock, A. J., Noordegraaf, A. V., Beghetti, M., et al. (2015) · Kardiologia Polska · doi:10.5603/kp.2015.0242 · Cited by 512 · see citing works
The Randomized Registry Trial — The Next Disruptive Technology in Clinical Research?
Lauer, M. S., & D'Agostino, R. B. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1310102 · Cited by 497 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya‐Mitjans, À., de Lange, F. J., Deharo, J., Elliot, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martiın, A., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0161 · Cited by 474 · see citing works
Roffi, M., Patrono, C., Collet, J., Mueller, C. E., Valgimigli, M., Andreotti, F., Bax, J. J., Borger, M. A., Brotons, C., Chew, D. P., et al. (2015) · Kardiologia Polska · doi:10.5603/kp.2015.0243 · Cited by 459 · see citing works
Self-citationPriori, S. G., Blomström‐Lundqvist, C., Mazzanti, A., Blom, N. A., Borggrefe, M., Camm, A. J., Elliot, P. M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015) · Kardiologia Polska · doi:10.5603/kp.2015.0190 · Cited by 450 · see citing works
Brott, T. G., Halperin, J. L., Abbara, S., Bacharach, J. M., Barr, J. D., Bush, R. L., Cates, C. U., Creager, M. A., Fowler, S. A., Friday, G. H., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.11.006 · Cited by 448 · see citing works
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 408 · see citing works
New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management
Kristensen, S. D., & Knuuti, J. M. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu285 · Cited by 384 · see citing works
Priori, S. G., & Blomström‐Lundqvist, C. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv445 · Cited by 344 · see citing works
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177031 · Cited by 341 · see citing works
Self-citationRegistry-based randomized clinical trials—a new clinical trial paradigm
James, S., Rao, S. V., & Granger, C. B. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.33 · Cited by 331 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Guía de práctica clínica para el diagnóstico y manejo del síncope (versión 2009)
Moya‐Mitjans, À., Sutton, R., Ammirati, F., Blanc, J., Brignole, M., Dahm, J. B., Deharo, J., Gajek, J. J., Gjesdal, K., Krahn, A. D., et al. (2009) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(09)73541-8 · Cited by 277 · see citing works
Improving patient care by linking evidence-based medicine and evidence-based management.
Shortell, S. M., Rundall, T. G., & Hsu, J. (2007) · JAMA · doi:10.1001/jama.298.6.673 · Cited by 275 · see citing works
Michel Komajda, N., Cowie, M., Tavazzi, L., Ponikowski, P. P., Anker, S. D., & Filippatos, G. S. (2017) · European Journal of Heart Failure · doi:10.1002/ejhf.887 · Cited by 263 · see citing works
Sex and gender differences in symptoms of myocardial ischaemia
Regitz‐Zagrosek, V. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr272 · Cited by 232 · see citing works
2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.09.019 · Cited by 208 · see citing works
Aboyans, V., Ricco, J., Bartelink, M.-L., et al. (2017) · Kardiologia Polska · doi:10.5603/kp.2017.0216 · Cited by 205 · see citing works
ACC/AHA 2004 guideline update for coronary artery bypass graft surgery
the American Association for Thoracic Surgery, & the Society of Thoracic Surgeons (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.08.002 · Cited by 187 · see citing works
Lee, D. H., & Vielemeyer, O. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.482 · Cited by 173 · see citing works
Poonacha, T. K., & Go, R. S. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2010.31.6414 · Cited by 158 · see citing works
Lip, G. Y. H., Laroche, C., Popescu, M. I., Rasmussen, L. H., Vitali-Serdoz, L., Dan, G.-A., Kalarus, Z., Crijns, H. J. G. M., Oliveira, M. M., Tavazzi, L., et al. (2015) · Europace · doi:10.1093/europace/euv269 · Cited by 151 · see citing works
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.036 · Cited by 138 · see citing works
The ADAPTABLE Trial and PCORnet: Shining Light on a New Research Paradigm
Hernandez, A. F., Fleurence, R., & Rothman, R. L. (2015) · Annals of Internal Medicine · doi:10.7326/m15-1460 · Cited by 108 · see citing works
[2018 ESC/EACTS Guidelines on myocardial revascularization].
Neumann, F., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A., Benedetto, U., Byrne, R., Collet, J., Falk, V., Head, S., et al. (2018) · Kardiologia polska · doi:10.5603/kp.2018.0228 · Cited by 108 · see citing works
Self-citationGUIDELINES ON THE PREVENTION, DIAGNOSIS, AND TREATMENT OF INFECTIVE ENDOCARDITIS (NEW VERSION 2009)
Habib, G., Hoen, B., Tornos, P., Thuny, F., Prendergast, B., Vilacosta, I., Moreillon, P., Antunes, M. J., Thilén, U., Lekakis, J. P., et al. (2010) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2010-6-5-733-746 · Cited by 96 · see citing works
Mini-Sentinel and Regulatory Science — Big Data Rendered Fit and Functional
Psaty, B. M., & Breckenridge, A. M. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1401664 · Cited by 90 · see citing works
Neuman, M. D., Goldstein, J. N., Cirullo, M. A., & Schwartz, J. S. (2014) · JAMA · doi:10.1001/jama.2014.4949 · Cited by 89 · see citing works
Wright, J. D., Pawar, N., Gonzalez, J. S. R., Lewin, S. N., Burke, W. M., Simpson, L. L., Charles, A. S., D’Alton, M. E., & Herzog, T. J. (2011) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3182267f43 · Cited by 84 · see citing works
The Endocrine Society Guidelines: When the Confidence Cart Goes Before the Evidence Horse
Brito, J. P., Domecq, J. P., Murad, M. H., Guyatt, G. H., & Montori, V. M. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1814 · Cited by 74 · see citing works
Koh, C., Zhao, X., Samala, N. R., et al. (2013) · Hepatology · doi:10.1002/hep.26578 · Cited by 60 · see citing works
Feuerstein, J. D., Akbari, M., Gifford, A. E., Cullen, G., Leffler, D. A., Sheth, S. G., & Cheifetz, A. S. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12290 · Cited by 45 · see citing works
Feuerstein, J. D., Akbari, M., Gifford, A. E., et al. (2014) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2013.09.013 · Cited by 38 · see citing works
Venkatesh, A. K., Savage, D., Sandefur, B. J., Bernard, K., Rothenberg, C., & Schuur, J. D. (2017) · PLoS ONE · doi:10.1371/journal.pone.0178456 · Cited by 38 · see citing works
Doing the Right Things and Doing Them the Right Way
Mehta, R. H., Chen, A. Y., Alexander, K. P., et al. (2015) · Circulation · doi:10.1161/circulationaha.114.013451 · Cited by 36 · see citing works
The Evidence Basis for the American College of Rheumatology Practice Guidelines
Duarte‐García, A., Zamore, R., & Wong, J. B. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.6680 · 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
Fanaroff, A. C., Steffel, J., Alexander, J. H., Lip, G. Y. H., Califf, R. M., & Lópes, R. D. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy236 · Cited by 27 · see citing works
Self-citationMeyer, C. L., Bowers, A., Wayant, C., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0204720 · Cited by 24 · see citing works
Povsic, T. J., Scott, R. C., Mahaffey, K. W., Blaustein, R. O., Edelberg, J. M., Lefkowitz, M. P., Solomon, S. D., Fox, J. C., Healy, K. E., Khakoo, A. Y., et al. (2017) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-017-6739-9 · Cited by 12 · see citing works
A Path Forward for Regenerative Medicine
Fanaroff, A. C., Morrow, V., Krucoff, M. W., Seltzer, J. H., Perin, E. C., Taylor, D. A., Miller, L. W., Zeiher, A. M., Fernández‐Avilés, F., Losordo, D. W., et al. (2018) · Circulation Research · doi:10.1161/circresaha.118.313261 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
1 of the 168 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Hoenders, R. H. J., Ghelman, R., Portella, C. F. S., Simmons, S., Locke, A., Cramer, H., Gallego-Pérez, D. F., & Jong, M. C. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1395698 · Cited by 165 · see citing works
Lópes, R. D., Hong, H., Harskamp, R. E., Bhatt, D. L., Mehran, R., Cannon, C. P., Granger, C. B., Verheugt, F. W. A., Li, J., ten Berg, J. M., et al. (2020) · JAMA Cardiology · doi:10.1001/jamacardio.2019.6175 · Cited by 128 · see citing works
Self-citationSodium Glucose Cotransporter-2 Inhibition for Acute Myocardial Infarction
Udell, J. A., Jones, W. S., Petrie, M. C., Harrington, J., Anker, S. D., Bhatt, D. L., Hernandez, A. F., & Butler, J. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.03.353 · Cited by 107 · see citing works
Lunny, C., Ramasubbu, C., Puil, L. J., Liu, T. W. B., Gerrish, S., Salzwedel, D. M., Mintzes, B. J., & Wright, J. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250356 · Cited by 83 · see citing works
The Integration of Clinical Trials With the Practice of Medicine
Angus, D. C., Huang, A. J., Lewis, R. J., Abernethy, A. P., Califf, R. M., Landray, M., KASS, N. E., Bibbins-Domingo, K. B., Abbasi, A. B., Abebe, K. Z., et al. (2024) · JAMA · doi:10.1001/jama.2024.4088 · Cited by 79 · see citing works
Self-citationRavaud, P., Créquit, P., Williams, H. C., Meerpohl, J. J., Craig, J. C., & Boutron, I. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.01.027 · Cited by 70 · see citing works
Randomized Trials Versus Common Sense and Clinical Observation
Fanaroff, A. C., Califf, R. M., Harrington, R. A., Granger, C. B., McMurray, J. J. V., Patel, M. R., Bhatt, D. L., Windecker, S., Hernandez, A. F., Gibson, C. M., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.05.069 · Cited by 76 · see citing works
“Fewer than 15% of European and American cardiology guideline recommendations are supported by evidence from RCTs, a proportion that has not changed over the past decade (95).”
Self-citationWong, S., Gishen, F., & Lokugamage, A. U. (2021) · London Review of Education · doi:10.14324/lre.19.1.16 · Cited by 90 · see citing works
“For example, ambiguity surrounding the grade of evidence behind published clinical recommendations (NICE guidelines, for example) has come under fire, especially as an increasing number of studies reveal a surprising lack of high-quality evidence behind widely accepted and practised guidelines (Fanaroff et al., 2019;…”
BackgroundDigital clinical trials: creating a vision for the future
Steinhubl, S. R., Wolff-Hughes, D. L., Nilsen, W., Iturriaga, E., & Califf, R. M. (2019) · npj Digital Medicine · doi:10.1038/s41746-019-0203-0 · Cited by 71 · see citing works
Self-citationEvidence from Pragmatic Trials during Routine Care — Slouching toward a Learning Health System
Simon, G. E., Platt, R. G., & Hernandez, A. F. (2020) · New England Journal of Medicine · doi:10.1056/nejmp1915448 · Cited by 54 · see citing works
Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology
Boriani, G., Vitolo, M., Lane, D. A., Potpara, T., & Lip, G. Y. H. (2021) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2021.01.006 · Cited by 58 · see citing works
Representativeness in randomised clinical trials supporting acute coronary syndrome guidelines
Mas-Lladó, C., González‐Del‐Hoyo, M., Siquier-Padilla, J., Peña, L. B., Coughlan, J. J., de la Villa, B. G., Peral, V., & Rosselló, X. (2023) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcad007 · Cited by 56 · see citing works
“13 Previous reports appraising CPGs content have mainly focused on tabulating the number of recommendations according to their class and LOE, 14,15 or evaluating the LOE based on the type of funding 16 or the type of management (e.g. recommendations regarding therapeutic or diagnostic approaches).”
BackgroundDrug Repurposing - Hypothesis, Molecular Aspects and Therapeutic Applications
Badria, F. A.-E. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.83082 · Cited by 53 · see citing works
Use of pragmatic and explanatory trial designs in acute care research: lessons from COVID-19
Casey, J. D., Beskow, L. M., Brown, J., Brown, S. M., Gayat, É., Gong, M. N., Harhay, M. O., Jaber, S., Jentzer, J. C., Laterre, P., et al. (2022) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(22)00044-3 · Cited by 52 · see citing works
Low, Y. S., Jackson, M. L., Hyde, R. J., Brown, R. E., Sanghavi, N. M., Baldwin, J. D., Pike, C. W., Muralidharan, J., Hui, G., Alexander, N., et al. (2025) · DIGITAL HEALTH · doi:10.1177/20552076251348850 · Cited by 51 · see citing works
“5,6 This creates a need for timely and relevant real-world evidence (RWE) to guide care and treatment decisions.”
Chen, Y., Harris, S. K., Rogers, Y., Ahmad, T., & Asselbergs, F. W. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac030 · Cited by 43 · see citing works
“For cardiologists, the scale of the opportunity may be significant, given that only a minority of recommendations in the current AHA or ESC guidelines is informed by Level A evidence.(1,78) Further, if and when insights are generated, there could be the virtuous cycle of nudge use in studying the adoption of such know…”
BackgroundTrends in the Explanatory or Pragmatic Nature of Cardiovascular Clinical Trials Over 2 Decades
Sepehrvand, N., Alemayehu, W. G., Das, D., Gupta, A., Gouda, P., Ghimire, A., Du, A., Hatami, S., Babadagli, H. E., Verma, S., et al. (2019) · JAMA Cardiology · doi:10.1001/jamacardio.2019.3604 · Cited by 41 · see citing works
Murayama, A., Yamada, K., Yoshida, M., Kaneda, Y., Saito, H., Sawano, T., Shrestha, S., Shrestha, R., Tanimoto, T. E., & Ozaki, A. (2022) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.14661121 · Cited by 32 · see citing works
Future of evidence ecosystem series: 2. current opportunities and need for better tools and methods
Créquit, P., Boutron, I., Meerpohl, J. J., Williams, H. C., Craig, J. C., & Ravaud, P. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.01.023 · Cited by 36 · see citing works
Elder, K., Turner, K. A., Cosgrove, L., Lexchin, J., Shnier, A., Moore, A. E., Straus, S. E., & Thombs, B. D. (2020) · Canadian Medical Association Journal · doi:10.1503/cmaj.191737 · Cited by 34 · see citing works
Applicability of European Society of Cardiology guidelines according to gross national income
van Dijk, W. B., Schuit, E., van der Graaf, R., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac606 · Cited by 36 · see citing works
Machine Learning to Optimize the Echocardiographic Follow-Up of Aortic Stenosis
Sánchez-Puente, A., Dorado-Díaz, P. I., Sampedro-Gómez, J., Bermejo, J., Martínez‐Legazpi, P., Fernández‐Avilés, F., Sánchez‐Gonzalez, J., del Villar, C. P., Vicente-Palacios, V., & Sanchez, P. L. (2023) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2022.12.008 · Cited by 34 · see citing works
Blackman, J., & Veerapen, R. J. (2025) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-025-02891-2 · Cited by 38 · see citing works
“…the clinicians that subsequently make use of the radiologists’ reports do not; we feel the comparison of black box cAI with clinical practice guidelines to be more apt, given that approximately half of guideline recommendations are based on expert-opinion alone without supporting evidence [57, 58].”
Yao, X., Attia, Z. I., Behnken, E., Walvatne, K., Giblon, R. E., Liu, S., Siontis, K. C., Gersh, B. J., Graff‐Radford, J., Rabinstein, A. A., et al. (2021) · American Heart Journal · doi:10.1016/j.ahj.2021.05.006 · Cited by 30 · see citing works
van Dijk, W. B., Grobbee, D. E., de Vries, M. C., et al. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319868540 · Cited by 29 · see citing works
New Approaches to Conducting Randomized Controlled Trials
Fanaroff, A. C., Califf, R. M., & Lópes, R. D. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.11.043 · Cited by 25 · see citing works
Self-citationLaserna, A., Rubinger, D. A., Correa, J. E. B., Wright, N., Williams, M. R., Wyrobek, J. A., Hasman, L., Lustik, S. J., Eaton, M. P., & Glance, L. G. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003808 · Cited by 27 · see citing works
“Ten years later, the extent to which cardiovascular guidelines rely on expert opinions has not changed significantly.(5) Similar findings have been reported for other medical and surgical subspecialties.”
BackgroundBreast cancer and cardiovascular health
López‐Fernández, T., Clement, I. M., Aznar, M. C., Barac, A., Bergler-Klein, J. K., Meattini, I., Scott, J. M., Cardinale, D. M., & Dent, S. F. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae637 · Cited by 27 · see citing works
Torp-Pedersen, C. T., Goette, A., Nielsen, P. B., Potpara, T., Fauchier, L., Camm, A. J., Arbelo, E., Boriani, G., Skjoeth, F., Rumsfeld, J. S., et al. (2019) · EP Europace · doi:10.1093/europace/euz210 · Cited by 27 · see citing works
Kaper, N. M., van der Heijden, G. J. M. G., Cuijpers, S. H., Stokroos, R. J., & Aarts, M. C. J. (2019) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-019-05752-7 · Cited by 25 · see citing works
National Institute for Health and Care Excellence (NICE) guidance on heart valve disease
Shah, B. N. (2023) · Heart · doi:10.1136/heartjnl-2022-321095 · Cited by 27 · see citing works
An informatics consult approach for generating clinical evidence for treatment decisions
Lai, A. G., Chang, W. H., Parisinos, C. A., Katsoulis, M., Blackburn, R. M., Shah, A. D., Nguyen, V. G., Denaxas, S., Smith, G. D., Gaunt, T. R., et al. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01638-z · Cited by 27 · see citing works
Miles, K. E., Rodriguez, R. W., Gross, A. E., & Kalil, A. C. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab033 · Cited by 26 · see citing works
Modernizing the Data Infrastructure for Clinical Research to Meet Evolving Demands for Evidence
Franklin, J. B., Marra, C., Abebe, K. Z., et al. (2024) · JAMA · doi:10.1001/jama.2024.0268 · Cited by 25 · see citing works
Self-citationBoriani, 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
O'Leary, C. P., & Cavender, M. A. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13948 · Cited by 23 · see citing works
Desai, A. P., Go, R. S., & Poonacha, T. K. (2020) · International Journal of Cancer · doi:10.1002/ijc.33215 · Cited by 23 · see citing works
How to shape the future of cardiology and cardiac surgery?
Dreyfus, G., & Windecker, S. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa707 · Cited by 22 · see citing works
Self-citationNon-vitamin K antagonist oral anticoagulants in patients with valvular heart disease
Fanaroff, A. C., Vora, A. N., & Lópes, R. D. (2022) · European Heart Journal Supplements · doi:10.1093/eurheartj/suab151 · Cited by 22 · see citing works
“This confusion is particularly significant because it limits the application of evidence-based treatment in patients with valvular heart disease, an area of cardiology with particularly limited evidence from randomized clinical trials to guide care.(5) In reality, many patients with valvular heart disease were include…”
BackgroundSelf-citationQuality-of-Care Measures for Cardio-Oncology
Rao, V. U., Deswal, A. M., Lenihan, D. J., Dent, S. F., López‐Fernández, T., Lyon, A. R., Barac, A., Palaskas, N. L., Chen, M. H., Villarraga, H. R., et al. (2025) · JACC CardioOncology · doi:10.1016/j.jaccao.2024.11.003 · Cited by 23 · see citing works
What can a learning healthcare system teach us about improving outcomes?
Casey, J. D., Courtright, K. R., Rice, T. W., & Semler, M. W. (2021) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000857 · Cited by 17 · see citing works
Lunny, C., Ramasubbu, C., Gerrish, S., Liu, T. W. B., Salzwedel, D. M., Puil, L. J., Mintzes, B. J., & Wright, J. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-031442 · Cited by 19 · see citing works
Individualized Care Is Superior to Standardized Care for the Majority of Critically Ill Patients
Cortés‐Puch, I., Applefeld, W. N., Wang, J., et al. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004373 · Cited by 19 · see citing works
Milojevic, M., Freemantle, N., Hayanga, J. W. A., Kelly, R. F., Myers, P. O., Petersen, R. H., Opitz, I., Sabik, J. F., & Bakaeen, F. G. (2024) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2024.07.048 · Cited by 18 · see citing works
“8 In addition, the rapid proliferation of medical knowledge, anticipated to double at least every 73 days, 9 underscores the essential need for reliable practice guidelines in medicine.”
BackgroundGlance, L. G., Thirukumaran, C. P., Feng, C., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.18449 · Cited by 18 · see citing works
Murayama, A., Kamamoto, S., Kawashima, M., Saito, H., Yamashita, E., Tanimoto, T. E., & Ozaki, A. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-068237 · Cited by 14 · see citing works
The Evidence Supporting Cardiovascular Guidelines
Bonow, R. O., & D, E. B. M. (2019) · JAMA · doi:10.1001/jama.2019.2018 · Cited by 18 · see citing works
Boussageon, R., Blanchard, C., Charuel, É., Ménini, T., Pereira, B., Naudet, F., Kassaï, B., Gueyffier, F., Cucherat, M., & Vaillant-Roussel, H. (2022) · Therapies · doi:10.1016/j.therap.2022.10.008 · Cited by 15 · see citing works
Campogiani, L., Tejada, S., Ferreira‐Coimbra, J., et al. (2019) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-019-03748-z · Cited by 17 · see citing works
Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022
MacDonald, B. J., & Turgeon, R. D. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.32793 · Cited by 17 · see citing works
Murayama, A. (2023) · Cureus · doi:10.7759/cureus.46650 · Cited by 11 · see citing works
Lópes, R. D., Hong, H., & Alexander, J. H. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz823 · Cited by 15 · see citing works
Self-citationType of evidence supporting ACC/AHA and ESC clinical practice guidelines for acute coronary syndrome
González-del-Hoyo, M., Mas-Lladó, C., Blaya-Peña, L., Siquier-Padilla, J., Coughlan, J., Peral, V., & Rosselló, X. (2023) · Clinical Research in Cardiology · doi:10.1007/s00392-023-02262-9 · Cited by 10 · see citing works
“…CPGs published between 2008 and 2018 from both the ACC/AHA and ESC CPGs, the number of recommendations supported by either randomised data or meta-analyses was limited to less than 9%, whereas up to 42% of recommendations were based on expert opinion and evidence from smaller registries [12, 13].”
High-quality evidence to inform clinical practice
Fanaroff, A. C., Califf, R. M., & Lópes, R. D. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31256-5 · Cited by 14 · see citing works
Self-citationHuang, G., Gupta, S., Davis, K., Barnes, E. W., Beekmann, S. E., Polgreen, P. M., & Peacock, J. E. (2020) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaa342 · Cited by 13 · see citing works
Cardio-Oncology Guidelines and Strength of the Evidence
Zheng, H., & Zhan, H. (2023) · JACC CardioOncology · doi:10.1016/j.jaccao.2022.12.001 · Cited by 13 · see citing works
Post-approval evidence generation: a shared responsibility for healthcare
Abbasi, A. B., Rivera, D. R. R., Curtis, L. H., et al. (2024) · Nature Medicine · doi:10.1038/s41591-024-03241-x · Cited by 13 · see citing works
Self-citationThe Health and Care Act 2022: challenges and priorities for embedding research in the NHS
Toh, C., & Haynes, R. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01195-3 · Cited by 12 · see citing works
Goyal, A., Schibler, T., Alhanti, B., Hannan, K. L., Granger, C. B., Blazing, M. A., Lópes, R. D., Alexander, J. H., Peterson, E. D., Rao, S. V., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.17963 · Cited by 12 · see citing works
Self-citationLevels of evidence supporting European and American community-acquired pneumonia guidelines
Ferreira‐Coimbra, J., Tejada, S., Campogiani, L., & Rello, J. (2020) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-020-03833-8 · Cited by 12 · see citing works
The scale of scientific evidence behind the current ESC clinical guidelines
Tantawy, M. A., Marwan, M., Hussien, S., et al. (2023) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2023.101175 · Cited by 11 · see citing works
Singleton, M. N., & Soffin, E. M. (2020) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2020-101653 · Cited by 11 · see citing works
Sinha, S. S., Bohula, E. A., van Diepen, S., Leonardi, S., Mebazaa, A., Proudfoot, A. G., Sionís, A., Chia, Y. W., Zampieri, F. G., Lópes, R. D., et al. (2022) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2022.06.007 · Cited by 10 · see citing works
Self-citationFanaroff, 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
Self-citationXu, E., Tejada, S., Solé-Lleonart, C., Campogiani, L., Valenzuela-Sánchez, F., Koulenti, D., & Rello, J. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2020.07.004 · Cited by 10 · see citing works
Guidelines and evidence-based recommendations in anaesthesia: where do we stand?
Rong, L. Q., Audisio, K., & O’Shaughnessy, S. M. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.02.025 · Cited by 9 · see citing works
Equipoise in Clinical Trials: Enough Uncertainty in Whose Opinion?
Alexander, J. H. (2022) · Circulation · doi:10.1161/circulationaha.121.057201 · Cited by 10 · see citing works
Characteristics of non-randomised studies of drug treatments: cross sectional study
Yaacoub, S. G., Porcher, R., Pellat, A., Bonnet, H., Tran, V.-T., Ravaud, P., & Boutron, I. (2024) · BMJ Medicine · doi:10.1136/bmjmed-2024-000932 · Cited by 10 · see citing works
Reduced DTI-ALPS in H-type hypertension: insights into perivascular space function
Zhang, C., Song, C., Sheng, S., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1536001 · Cited by 9 · see citing works
Adaptive Trials in Cardiology: Some Considerations and Examples
Mandrola, J. M., Althouse, A. D., Foy, A., et al. (2021) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2021.06.023 · Cited by 9 · see citing works
Shigeta, H., Murayama, A., Kamamoto, S., Saito, H., & Ozaki, A. (2023) · Cureus · doi:10.7759/cureus.36567 · Cited by 7 · see citing works
Blais, S., Marelli, A. J., Vanasse, A., Dahdah, N., Dancea, A., Drolet, C., & Dallaire, F. (2020) · CJC Open · doi:10.1016/j.cjco.2020.06.012 · Cited by 10 · see citing works
Kinalski, M. D. A., Sarkis‐Onofre, R., & dos Santos, M. B. F. (2020) · Australian Dental Journal · doi:10.1111/adj.12813 · Cited by 9 · see citing works
Pavlović, J., Greenland, P., Franco, O. H., Kavousi, M., Ikram, M. K., Deckers, J. W., Ikram, M. A., & Leening, M. J. G. (2021) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.120.007183 · Cited by 9 · see citing works
Assessing Artificial Intelligence Solution Effectiveness: The Role of Pragmatic Trials
Jin, M. F., Noseworthy, P. A., & Yao, X. (2024) · Mayo Clinic Proceedings Digital Health · doi:10.1016/j.mcpdig.2024.06.010 · Cited by 9 · see citing works
PCSK9 Inhibitors and Anthracyclines: The Future of Cardioprotection in Cardio-Oncology
Repp, M. L., Edwards, M. D., Burch, C. S., Rao, A., & Chinyere, I. R. (2024) · Hearts · doi:10.3390/hearts5030027 · Cited by 8 · see citing works
Trottet, C., Vogels, T., Keitel, K., Kulinkina, A. V., Tan, R., Cobuccio, L. G., Jaggi, M., & Hartley, M. (2023) · PLOS Digital Health · doi:10.1371/journal.pdig.0000108 · Cited by 8 · see citing works
Quantitating Mitral Regurgitation in Clinical Trials: The Need for a Uniform Approach
Gammie, J. S., Grayburn, P. A., Quinn, R. W., et al. (2021) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2021.03.073 · Cited by 8 · see citing works
McCall, S. J., Imran, M., Hemkens, L. G., Cord, K. A. M., Kwakkenbos, L., Sampson, M., Jawad, S., Zwarenstein, M., Relton, C., Langan, S., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.09.011 · Cited by 8 · see citing works
Dash, D., Gokhale, A., Patel, B., Callahan, A., Posada, J., Krishnan, G., Collins, W. J., Li, R., Schulman, K. A., Ren, L. Y., et al. (2022) · Applied Clinical Informatics · doi:10.1055/s-0042-1743241 · Cited by 7 · see citing works
Pallotto, C., Bolla, C., Penpa, S., et al. (2023) · Antibiotics · doi:10.3390/antibiotics12040705 · Cited by 7 · see citing works
“Moreover, the level of evidence that supports guidelines was only elevated for a small percentage of recommendations [22,23].”
BackgroundMilojevic, M., Freemantle, N., Hayanga, J. W. A., Kelly, R. F., Myers, P. O., Petersen, R. H., Opitz, I., Sabik, J. F., & Bakaeen, F. G. (2024) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezae345 · Cited by 10 · see citing works
Li, C., Wang, C., Hao, J., Zheng, Y., Yang, J., Wang, W., & Tang, Y. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2023.100773 · Cited by 6 · see citing works
Andronic, O., Lu, V., Claydon, L. S., Cubberley, R., Panel, I. F. E., & Khanduja, V. (2023) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2023.12.010 · Cited by 8 · see citing works
Ohm, J., Jernberg, T., Johansson, D., et al. (2021) · European Heart Journal Open · doi:10.1093/ehjopen/oeab020 · Cited by 7 · see citing works
Gehle, H.-A., & Herrmann, H. (2020) · Journal of European CME · doi:10.1080/21614083.2020.1811557 · Cited by 7 · see citing works
The Quality of Evidence Supporting Clinical Practice Guidelines in General Surgery
Abbasi, A. B., Valderrama, A., Decker, H. C., et al. (2024) · JAMA Surgery · doi:10.1001/jamasurg.2024.4751 · Cited by 6 · see citing works
Consequences of Slow Progress Toward Pragmatism in Randomized Clinical Trials
Rodríguez, F., Califf, R. M., & Harrington, R. A. (2019) · JAMA Cardiology · doi:10.1001/jamacardio.2019.3922 · Cited by 6 · see citing works
Self-citationGarrett, E. P., Hightower, B., Walters, C. G., Srouji, D., Chronister, J., Torgerson, T., Hartwell, M. L., McIntire, R., Love, M., & Vassar, M. B. (2022) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2021-111859 · Cited by 6 · see citing works
Partogi, M., Gaviria-Valencia, S., Aguirre, M. A., Pick, N. J., Bhopalwala, H. M., Barry, B. A., Kaggal, V. C., Scott, C. G., Kessler, M., Moore, M. M., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/27333 · Cited by 5 · see citing works
Canepa, M., Marzo, V. D., Ameri, P., Ferrari, R., Tavazzi, L., Rapezzi, C., Porto, I., & Maggioni, A. P. (2023) · ESC Heart Failure · doi:10.1002/ehf2.14459 · Cited by 5 · see citing works
“documents published in the last four decades were supported by evidence from RCTs, without any important change over time.(5,6) Notably, these review manuscripts were primarily”
BackgroundMethodResultInfluentialLevels of evidence supporting clinical practice guidelines on invasive aspergillosis
Tejada, S., Campogiani, L., Ferreira‐Coimbra, J., et al. (2020) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-019-03794-7 · Cited by 6 · see citing works
Outcomes in CME/CPD - Special Collection: How to make the “pyramid” a perpetuum mobile
Griebenow, R., Mills, P. G., STEIN, J. I., Herrmann, H., Kelm, M., Campbell, C., & Schäfer, R. (2020) · Journal of European CME · doi:10.1080/21614083.2020.1832750 · Cited by 6 · see citing works
Translation of scientific evidence into cardiovascular guidelines
Koller, Á., & Takács, J. (2020) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000266 · Cited by 6 · see citing works
Nagavci, B., Schwingshackl, L., Martín‐Loeches, I., & Lakatos, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306098 · Cited by 5 · see citing works
Clinical decision making in healthcare: the importance of best evidence
Flumignan, R. L., & Lópes, R. D. (2025) · Jornal Vascular Brasileiro · doi:10.1590/1677-5449.202401302 · Cited by 5 · see citing works
“Fanaroff et al. 3 investigated the quality of the scientific evidence supporting the recommendations contained in the leading international cardiology guidelines.”
Self-citationFayyaz, K., Saeeduddin, M., Bashir, H., Ahmad, F., Barrow, C. J., & Khalid, N. (2025) · Nutrients · doi:10.3390/nu17172804 · Cited by 5 · see citing works
“An assessment revealed that only 10% of ACC/AHA and 15% of ESC guidelines are supported by high-quality RCTs [68].”
Optimizing Informed Consent—A Call to Action
KASS, N. E., Meeker-O’Connell, A., Morain, S. R., et al. (2025) · JAMA Health Forum · doi:10.1001/jamahealthforum.2025.0824 · Cited by 5 · see citing works
Yazbeck, B., Boutron, I., Porcher, R., Riveros, C., Ravaud, P., & Yaacoub, S. G. (2025) · BMC Medicine · doi:10.1186/s12916-025-04257-x · Cited by 4 · see citing works
“There is a pressing need to assess the impact of adherence to CPGs on clinical outcomes, specifically that many recommendations are not based on high level of evidence [7, 8].”
Indispensable but deceptive evidence-based medicine
Funck‐Brentano, C. (2020) · Diabetes & Metabolism · doi:10.1016/j.diabet.2020.09.006 · Cited by 5 · see citing works
- Authors
- Fanaroff, A. C., Califf, R. M., Windecker, S., Smith, S. C., & Lopes, R. D.
- Affiliations
- Duke University (US)
- University of Bern (CH)
- University of North Carolina at Chapel Hill (US)
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-19
- Volume
- 321
- Issue
- 11
- Pages
- 1069
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6439920
- OpenAlex
- W2921176698
- Cited by
- 228
- References
- 168
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 30 · 2023: 28 · 2022: 32 · 2021: 30 · 2020: 39 · 2019: 22
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- American Heart Association (17FTF33661087)
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- Biogen
- Edwards Lifesciences
- Boston Scientific Corporation
- Cytokinetics
- Genentech
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- level of evidence, cardiovascular guidelines, ACC/AHA guidelines, ESC guidelines, randomized controlled trials, guideline recommendations, expert opinion, guideline revision, cardiovascular care
- MeSH terms
- American Heart Association, Cardiology, Cardiovascular Diseases, Europe, Societies, Medical, United States, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Evidence-Based Medicine, Observational Studies as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
