Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease

Aya J. Alame, Aris Karatasakis, Judit Karacsonyi, Barbara A. Danek, Paul Sorajja, Mario Gössl, Santiago Garcia, Hani Jneid, Nikolaos Kakouros, Jose Roberto Martinez-Parachini, Erica Resendes, Pratik Kalsaria, Michele Roesle, Bavana V. Rangan, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have developed guidelines to assist clinicians in making evidence-based decisions. This study compares the ACC/AHA and ESC guidelines for the management of patients with valvular heart disease (VHD). METHODS: The current ACC/AHA and ESC guidelines for VHD, last updated in 2014 and 2012, respectively, were compared by class of recommendation (COR), level of evidence (LOE), and content. RESULTS: The ACC/AHA and ESC VHD guidelines contain 229 and 85 recommendations, respectively. The COR distributions of the ACC/AHA and ESC VHD guidelines were 47.6% vs 44.7% class I [P≤.65]; 46.3% vs 55.3% class II [P≤.16]; and 6.1% vs 0.0% class III [P≤.01], respectively. The LOE distributions were 3.1% vs 0.0% LOE A [P≤.20]; 47.2% vs 10.6% LOE B [P<.001]; and 49.8% vs 89.4% LOE C [P<.001], respectively. The recommendation type distributions were 31.0% vs 2.4% diagnostic [P<.001]; 23.1% vs 16.5% medical therapy [P≤.20]; and 45.9% vs 81.2% interventional/surgical recommendations [P<.001], respectively. The content of the guidelines was similar, with only minor differences in a few recommendations. CONCLUSIONS: The ACC/AHA VHD guidelines contain significantly more recommendations. The distribution of COR was similar, but the ACC/AHA guidelines included more LOE B recommendations and fewer LOE C recommendations, suggesting that the ACC/AHA guidelines place greater emphasis on published data than expert opinion. Overall, the ACC/AHA and ESC guidelines provide similar recommendations, suggesting consistency in practice; however, the relative paucity of LOE A recommendations highlights the need for additional research.

Original languageEnglish (US)
Pages (from-to)320-326
Number of pages7
JournalJournal of Invasive Cardiology
Volume29
Issue number9
StatePublished - Sep 1 2017

Keywords

  • guidelines
  • outcomes
  • quality
  • valvular heart disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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