| A critical analysis of the scientific evidence behind international guidelines related to cardiac arrhythmias. | |
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MedLine Citation:
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PMID: 21372270 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Guidelines have become very important in assisting with decision making in clinical practice. However, few studies have analyzed the level of evidence (LOE) underlying guidelines critically. This study aims to assess the accuracy of the referenced literature that has led to recommendations with a level of evidence A (LOE-A) rating. METHODS AND RESULTS: The latest updates of the practice guidelines related to arrhythmia posted on the European Society of Cardiology (ESC) web site were analyzed. The referenced literature for LOE-A recommendation was analyzed to reassess the proposed grading scheme for LOE-A. Furthermore, the clearly defined positive (Class I) and negative (Class III) recommendations with correctly referenced LOE-A were assessed. A median of 5.4% of all recommendations per guideline (interquartile range 4.9% to 9.7%) were categorized as LOE-A, but only 3.7% (IQR 3.4% to 4.9%) were accurately referenced as LOE-A. In total, 27 of 698 recommendations (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III LOE-A recommendations implying definite evidence-based positive or negative conclusion. CONCLUSIONS: Our findings raise the question of the accuracy of LOE-A in medical guidelines in general and highlight the importance of a critical use of all recommendations. Moreover, they underline the need for improving the guideline-writing process. Further randomized double-blinded and/or crossover-designed studies should focus on areas with a gap in the evidence, such as existing but not yet convincing (LOE-B) or conflicting (Class II) evidence. |
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Authors:
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Markus Roos; Jeannette Brodbeck; Andrea Sarkozy; Gian Battista Chierchia; Carlo De Asmundis; Pedro Brugada |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-03-03 |
Journal Detail:
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Title: Circulation. Arrhythmia and electrophysiology Volume: 4 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-20 Completed Date: 2011-06-17 Revised Date: 2012-02-03 |
Medline Journal Info:
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Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 202-10 Citation Subset: IM |
Affiliation:
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Heart Rhythm Management Center, Vrije Universiteit Brussel, Belgium. Belgium.roosmarkus@bluewin.ch |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Arrhythmias, Cardiac
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diagnosis,
therapy* Decision Support Techniques* Europe Evidence-Based Medicine / standards* Guideline Adherence Humans International Cooperation Internet Patient Selection* Practice Guidelines as Topic / standards* Quality of Health Care / standards Review Literature as Topic* Societies, Medical Writing / standards |
| Comments/Corrections | |
Comment In:
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Circ Arrhythm Electrophysiol. 2011 Apr;4(2):119-22
[PMID:
21505173
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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