Evolution of European Society of Cardiology Guidelines since 2000: a - - PowerPoint PPT Presentation

Evolution of European Society of Cardiology Guidelines since 2000: a systematic appraisal

Charles Badu-Boateng 1,2,3

Dr Arash Yavari 1,2 & Dr Rizwan Sarwar 1

1 Cardiology Department, John Radcliffe Hospital, Oxford University Hospitals 2 Cardiovascular Medicine, University of Oxford 3 GKT School of Medical Education, King’s College London

Declarations

• No conflicts of interest
• No funding to declare

• WHO data: cardiovascular diseases (CVDs) responsible for 31% of

all deaths worldwide

• European Society of Cardiology (ESC)

– association of 95,000 professionals – mission: ‘to reduce the burden of CVD in Europe’

• ESC produces Clinical Practice Guidelines to facilitate this mission

http://www.who.int/mediacentre/factsheets/fs317/en/

Introduction

ESC Guidelines

• Currently 24 active guidelines
• Periodically updated by ‘selected experts’ to clarify areas
• f consensus and disagreement
• Extensive review by the Committee of Practice Guidelines

and external experts

• Publication of guidelines

– in European Heart Journal – free online – free app

Recommendations within guidelines

• Strength of recommendations within

guidelines are weighed and graded according to pre-defined scales

– Class of Recommendation – Level of Evidence

Class of recommendation

  

Level of evidence

  

Previous work

• Prof Darrel Francis (Imperial College London)

– Abstract only 2014 – ESC guidelines 2000-13 – Not assessed class of recommendations – Levels of Evidence

• 18%

LoE A

• 32%

LoE B

• 50%

LoE C

Sau, Cole, Cook, Shun-Shin, Francis (2014) Systematic analysis of European Society of Cardiology guidelines: what do we actually base our practice on? Heart , 100(Suppl 3): A110.

Aim

• To evaluate the recommendations within ESC

guidelines from 2000-2015

Methods

• Guidelines

– retrieved all guidelines from ESC 2000-2015 – current and historical

• Every recommendation was identified manually

– Class of Recommendation (CoR) I, II, III – Level of Evidence (LoE) A, B, C

http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/ESC-Clinical-Practice-Guidelines-list/listing

Results

• 2000-2015

– 24 current guidelines – 49 inactive guidelines

• 3386 current recommendations

Class of Recommendations

• 41% current recommendations Class II
• No statistically significant changes in %ages over 15 years

Percentage

2000 2002 2004 2006 2008 2010 2012 2014 2016

Recommendations

2000 2002 2004 2006 2008 2010 2012 2014 2016

• Class I
• Class II
• Class III

Level of Evidence

• 52% of current recommendations were of Level C
• No statistically significant changes in %ages over 15 years

Percentage

2000 2002 2004 2006 2008 2010 2012 2014 2016

Recommendations

2000 2002 2004 2006 2008 2010 2012 2014 2016

• Level of Evidence A
• Level of Evidence B
• Level of Evidence C

3

Summary of 24 current guidelines

I II III 200 400 600 800 1000 A B C

Level of Evidence

Class of Recommendations

Conclusions

• 2000 to 2015:

– 20-fold increase in recommendations – 41% recommendations CoR II (unlike definitive CoR I or III) – 52% recommendations LoE C – ….too many recommendations which are not based on high level evidence and not definitive

• There is a need to improve LoE underpinning current ESC

guidelines to promote definitive guidance

• Dr Rizwan Sarwar
• Dr Arash Yavari

Acknowledgement

End

Results summary table

`LoE – A LoE - B LoE- C LoE - U Total CoR - I 415 498 787 38 1738 CoR - II 87 474 839 16 1416 CoR - III 54 83 149 11 297 CoR - U 43 58 37 138 599 1113 1812 65 3589 LoE - A LoE - B LoE- C LoE - U CoR - I 12% 14% 22% 1% 48% CoR - II 2% 13% 23% 0% 39% CoR - III 2% 2% 4% 0% 8% CoR - U 1% 2% 1% 0% 4% 17% 31% 50% 2% 100%