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Strength of Evidence Underlying the American Heart Association/American College of Cardiology Guidelines on Endovascular and Surgical Treatment of Peripheral Vascular Disease.
Sardar, Partha; Giri, Jay; Jaff, Michael R; Parikh, Sahil A; Kundu, Amartya; White, Christopher J; Chatterjee, Saurav; Kennedy, Kevin F; Desai, Nihar R; Hyder, Omar N; Mukherjee, Debabrata; Shishehbor, Mehdi H; Abbott, J Dawn; Aronow, Herbert D.
Afiliación
  • Sardar P; Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.).
  • Giri J; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia (J.G.).
  • Jaff MR; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia (J.G.).
  • Parikh SA; Department of Medicine, Newton-Wellesley Hospital, Newton, MA (M.R.J.).
  • Kundu A; Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York Presbyterian Hospital (S.A.P.).
  • White CJ; Cardiovascular Medicine, University of Massachusetts Medical School, Worcester (A.K.).
  • Chatterjee S; Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinical School of the University of Queensland, Ochsner Medical Center, New Orleans, LA (C.J.W.).
  • Kennedy KF; Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford (S.C.).
  • Desai NR; Division of Cardiology, Mid America Heart and Vascular Institute, Saint Luke's Hospital, Kansas City, MO (K.F.K.).
  • Hyder ON; Division of Cardiology, Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, CT (N.R.D.).
  • Mukherjee D; Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.).
  • Shishehbor MH; Texas Tech University Health Sciences Center, El Paso (D.M.).
  • Abbott JD; Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.H.S.).
  • Aronow HD; Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.).
Circ Cardiovasc Interv ; 12(1): e007244, 2019 01.
Article en En | MEDLINE | ID: mdl-30608884
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Vasculares / Enfermedades Vasculares Periféricas / Guías de Práctica Clínica como Asunto / Medicina Basada en la Evidencia / Procedimientos Endovasculares / American Heart Association Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Vasculares / Enfermedades Vasculares Periféricas / Guías de Práctica Clínica como Asunto / Medicina Basada en la Evidencia / Procedimientos Endovasculares / American Heart Association Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Circ Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos