AI Article Synopsis
- The study aimed to assess the evidence backing the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions.
- It found that out of 134 recommendations across five guidelines, only 13% were supported by high-quality evidence (Level of Evidence A), while most were rated lower (Class II – 54% and Class I – 35%).
- The study concludes that there is considerable inconsistency in the quality of evidence for these interventions, indicating a need for better data to inform guideline recommendations and potential updates.
Article Abstract
Background: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions.
Methods And Results: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence.
Conclusions: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.
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| http://dx.doi.org/10.1161/CIRCINTERVENTIONS.118.007244 | DOI Listing |
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