Clinical Practice Guidelines and Scientific Evidence
- Finlay A. McAlister, MD, MSc finlay.mcalister@ualberta.caDivision of General Internal MedicineUniversity of AlbertaEdmonton, Canada
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: In their study, Dr Tricoci and colleagues1 pointed out that less than one-fifth of recommendations advocating a particular procedure or treatment in ACC/AHA practice guidelines were based on level A evidence. However, in using the ACC/AHA evidence grading schema to judge the quality of evidence underpinning guideline recommendations, I believe they have overestimated the strength of this evidence base. For example, under the ACC/AHA schema RCTs or meta-analyses are deemed to be level A evidence (or at worst level B if there is only a single RCT or the RCTs are small) irrespective of study conduct, end points evaluated (surrogate outcomes vs patient-centered outcomes), or the applicability of that RCT to the clinical scenario for which the recommendation is being made.
In a study evaluating the evidence cited in support of cardiovascular treatment recommendations in 9 current national guidelines (from the United States, Canada, and Europe), …
