The DOI matches its Crossref record; 167 of the 168 references it cites were found in a registry or an index; none of the 11 sources its claims cite is checked for support yet.
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.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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“934 (49.6%) as LOE C”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 1622 class I recommendations, 349 (21.5%) were LOE A.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“ESC guidelines contained 1884 class I and class III recommendations, 402 (21.3%) classified as LOE A”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1217 (41.5%) as LOE C”
- Also stated in: § Results · plain
“1217 (41.5%) as LOE C”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 1272 class I recommendations, 180 (14.2%) were classified as LOE A.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of these recommendations, 207 (12.9%) were supported by LOE A evidence”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the proportion of recommendations that were LOE B (median, 31.7% [current] vs 33.4% [prior])”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > ESC Guidelines
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“612 (38.2%) by LOE C evidence”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 8
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%)”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § ESC Guidelines · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%)”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Changes From Prior to Current Guidelines ACC/AHA Guidelines · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In the intervening years, some of these steps have been taken, [6][7][8]”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Abstract
What the sources say
- Not checked yetcites [6][7][8]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“recommendations were abstracted by a single reviewer (A.C.F.) and validated by another reviewer (R.D.L).”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Methods
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Abstraction therefore involved simple reporting of the content of each document and did not require judgment on the part of the abstractors.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Methods
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Alternatively, standards for LOE A designation may have changed over time.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“however, this limitation should not affect findings regarding changes in LOE over time.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, the evidence supporting major society guideline recommendations is a surrogate for the totality of the evidence in cardiology, rather than a direct measurement.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“this increase in LOE B recommendations could indicate that the proportion of recommendations supported by randomized evidence is increasing”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“At that time, 12% of guideline recommendations were classified as LOE A, including 19% of class I recommendations.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
What the sources say
- Not checked yetcites [5] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“in these 6 guideline documents, they found minimal increases in LOE A recommendations compared with LOE B and C.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
What the sources say
- Not checked yetcites [5] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, this review describes only evidence supporting cardiology guidelines, rather than across medical and surgical subspecialties”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of evidence supporting each recommendation was not independently assessed”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Solid RCT evidence delineates treatments and strategies that lead to better patient outcomes, which can then be implemented in clinical practice.106”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
What the sources say
- Not checked yetcites [106] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018 > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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?
In the citing paper
“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”
Citations
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 20,604
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 13,739
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
Ahmed, A., Jorna, T., & Bhandari, S. (2016) · The Nephron journals/Nephron journals · doi:10.1159/000447068 · Cited by 11,782
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
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
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
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
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 8,487
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 8,348
Self-citation
Flagged first, then by citations
1 of the 168 references couldn’t be matched to a known paper.
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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 175
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 132
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 110
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 88
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 91
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 74
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 77
“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
“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
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
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
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
“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 52
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 56
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
“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 44
“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
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
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 37
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
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
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 33
Blackman, J., & Veerapen, R. J. (2025) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-025-02891-2 · Cited by 38
“…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 35
van Dijk, W. B., Grobbee, D. E., de Vries, M. C., Groenwold, R. H. H., van der Graaf, R., & Schuit, E. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319868540 · Cited by 27
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
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 26
“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 31
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
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
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
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
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
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
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
O'Leary, C. P., & Cavender, M. A. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13948 · Cited by 23
Desai, A. P., Go, R. S., & Poonacha, T. K. (2020) · International Journal of Cancer · doi:10.1002/ijc.33215 · Cited by 23
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
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
“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
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
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
Individualized Care Is Superior to Standardized Care for the Majority of Critically Ill Patients
Cortés‐Puch, I., Applefeld, W. N., Wang, J., Danner, R. L., Eichacker, P. Q., & Natanson, C. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004373 · Cited by 19
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
“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
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
The Evidence Supporting Cardiovascular Guidelines
Bonow, R. O., & D, E. B. M. (2019) · JAMA · doi:10.1001/jama.2019.2018 · Cited by 18
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
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
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
Murayama, A. (2023) · Cureus · doi:10.7759/cureus.46650 · Cited by 11
Lópes, R. D., Hong, H., & Alexander, J. H. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz823 · Cited by 16
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
“…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
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
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
Post-approval evidence generation: a shared responsibility for healthcare
Abbasi, A., Rivera, D., Curtis, L. H., & Califf, R. M. (2024) · Nature Medicine · doi:10.1038/s41591-024-03241-x · Cited by 13
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
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
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
The scale of scientific evidence behind the current ESC clinical guidelines
Tantawy, M. A., Marwan, M., Hussien, S., Tamara, A. F., & Mosaad, S. (2023) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2023.101175 · Cited by 12
Singleton, M. N., & Soffin, E. M. (2020) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2020-101653 · Cited by 11
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
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
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
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
Equipoise in Clinical Trials: Enough Uncertainty in Whose Opinion?
Alexander, J. H. (2022) · Circulation · doi:10.1161/circulationaha.121.057201 · Cited by 10
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
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
Adaptive Trials in Cardiology: Some Considerations and Examples
Mandrola, J. M., Althouse, A. D., Foy, A., & Bhatt, D. L. (2021) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2021.06.023 · Cited by 7
Shigeta, H., Murayama, A., Kamamoto, S., Saito, H., & Ozaki, A. (2023) · Cureus · doi:10.7759/cureus.36567 · Cited by 7
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
Kinalski, M. D. A., Sarkis‐Onofre, R., & dos Santos, M. B. F. (2020) · Australian Dental Journal · doi:10.1111/adj.12813 · Cited by 9
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
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 10
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
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 9
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
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
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
Pallotto, C., Bolla, C., Penpa, S., et al. (2023) · Antibiotics · doi:10.3390/antibiotics12040705 · Cited by 7
“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
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
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
Ohm, J., Jernberg, T., Johansson, D., Warnqvist, A., Leósdóttir, M., Hambræus, K., & Svensson, P. (2021) · European Heart Journal Open · doi:10.1093/ehjopen/oeab020 · Cited by 7
Gehle, H.-A., & Herrmann, H. (2020) · Journal of European CME · doi:10.1080/21614083.2020.1811557 · Cited by 7
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
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
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
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
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
“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
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 7
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
Nagavci, B., Schwingshackl, L., Martín‐Loeches, I., & Lakatos, B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306098 · Cited by 5
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
“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 7
“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
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
“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
Metadata
- 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
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