Clinical Practice Guidelines and Scientific Evidence
- Susan L. Norris, MD, MPH, MS norriss@ohsu.eduOregon Health & Science UniversityPortland
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ACUTE CORONARY SYNDROMES
- AMERICAN HEART ASSOCIATION
- CARDIOVASCULAR DISEASES
- CLINICAL TRIALS AS TOPIC
- EDUCATION, MEDICAL
- EVIDENCE-BASED MEDICINE
- HOSPITALS
- OUTCOME ASSESSMENT (HEALTH CARE)
- PRACTICE GUIDELINES AS TOPIC
To the Editor: Dr Tricoci and colleagues1 published an analysis indicating that American College of Cardiology/American Heart Association (ACC/AHA) guidelines are largely developed from lower levels of evidence or expert opinion. They concluded that there is a “need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived.” Their first conclusion could have been better substantiated by a critical appraisal of the ACC/AHA guideline methods.2
First, the ACC/AHA does not appear to follow Institute of Medicine recommendations to separate the systematic review process from guideline formulation.3 Rather, the same writers appear to perform both processes.
Second, the ACC/AHA uses an overly simplistic, outdated hierarchy of study design (randomized controlled trials [RCTs] at the top) to assess level of evidence. Different types of clinical questions are best answered with different study designs. Moreover, in several recent ACC/AHA guidelines …
