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
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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
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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
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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
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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.
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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
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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 5,086
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
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 4,802
Guyatt, G. H. (1992) · JAMA · doi:10.1001/jama.1992.03490170092032 · Cited by 4,577
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
Self-citationErbel (2014) · doi:10.1093/eurheartj/ehu281 · Cited by 4,451
Self-citation2014 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 4,408
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
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 4,217
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 4,137
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
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
Self-citationEuropean 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 3,865
Guidelines 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 3,853
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.002 · Cited by 3,845
Self-citationHirsch, 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
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
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
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
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
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
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention
Levine, G. N., Bates, E., Blankenship, J. C., Bailey, S. R., Bittl, J. A., Cercek, B., Chambers, C. E., Ellis, S. G., Guyton, R. A., Hollenberg, S. M., et al. (2011) · Circulation · doi:10.1161/cir.0b013e31823ba622 · Cited by 3,300
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
Self-citation2016 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
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
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 3,096
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
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 2,920
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 2,834
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
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
2015 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 2,727
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.003 · Cited by 2,691
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
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
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
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
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 2,419
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
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
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
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
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 2,213
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 2,182
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
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 2,116
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
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
Authors 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 1,994
Self-citationACC/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 1,982
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 1,976
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 1,972
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
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
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
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 1,902
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 1,839
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 1,772
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 1,702
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 1,700
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 1,687
Self-citationAuthors 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 1,671
Stout, 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
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 1,583
Self-citation2016 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
ACC/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 1,553
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
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 1,506
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 1,421
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.001 · Cited by 1,348
Self-citation2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
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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
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.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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 ›
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