Evolution of the American College of Cardiology/American Heart Association Clinical Guidelines

Henry Han, Howard Chao, Andres Guerra, Alan Sosa, Georgios Christopoulos, Georgios E. Christakopoulos, Bavana V. Rangan, Spyros Maragkoudakis, Hani Jneid, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have been developing clinical guidelines to assist practicing clinicians. Objectives The goal of this study was to evaluate changes in ACC/AHA guideline recommendations between 2008 and 2014. Methods The previous and current ACC/AHA guideline documents that were updated between 2008 and June 2014 were compared to determine changes in Class of Recommendation (COR) and Level of Evidence (LOE). Each recommendation was classified as new, dropped, revised, or unchanged, and the changes in evidence were examined. Results During the study period, 11 guideline documents (9 disease based and 2 interventional procedure based) were updated. The total number of recommendations decreased from 2,067 to 1,869 (321 fewer recommendations in disease-based guidelines and 123 additional recommendations in interventional procedure-based guidelines). The recommendation class distribution of the updated guidelines was 50.1% Class I (previously 50.8%), 39.4% Class II (previously 35.4%), and 10.4% Class III (previously 13.8%) (p = 0.001). The LOE distribution among updated versions was 15.0% for LOE: A (previously 13.3%), 50.8% for LOE: B (previously 41.4%), and 34.2% for LOE C (previously 45.3%) (p < 0.001). Among all guidelines, 859 recommendations were new, 1,339 were dropped, 881 were unchanged in COR and LOE, and 129 were revised. Of the revised guidelines, 75 recommendations had an increase in LOE (the majority from LOE: C to LOE: B); 34 recommendations had a decrease in LOE; and 20 recommendations had class changes. LOE increases were justified by introduction of new randomized controlled trials, new studies, and new meta-analyses. Conclusions The ACC/AHA guideline recommendations are undergoing significant changes, becoming more evidence based and scientifically robust with a tendency to exclude recommendations with insufficient scientific evidence.

Original languageEnglish (US)
Pages (from-to)2726-2734
Number of pages9
JournalJournal of the American College of Cardiology
Volume65
Issue number25
DOIs
StatePublished - Jun 30 2015

Fingerprint

Guidelines
American Heart Association
Cardiology
Meta-Analysis
Randomized Controlled Trials

Keywords

  • cardiovascular diseases
  • clinical guidelines
  • evolution
  • scientific evidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Evolution of the American College of Cardiology/American Heart Association Clinical Guidelines. / Han, Henry; Chao, Howard; Guerra, Andres; Sosa, Alan; Christopoulos, Georgios; Christakopoulos, Georgios E.; Rangan, Bavana V.; Maragkoudakis, Spyros; Jneid, Hani; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Journal of the American College of Cardiology, Vol. 65, No. 25, 30.06.2015, p. 2726-2734.

Research output: Contribution to journalArticle

Han, Henry ; Chao, Howard ; Guerra, Andres ; Sosa, Alan ; Christopoulos, Georgios ; Christakopoulos, Georgios E. ; Rangan, Bavana V. ; Maragkoudakis, Spyros ; Jneid, Hani ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Evolution of the American College of Cardiology/American Heart Association Clinical Guidelines. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 25. pp. 2726-2734.
@article{a520bfe7ce0144219ad462ec47b09a27,
title = "Evolution of the American College of Cardiology/American Heart Association Clinical Guidelines",
abstract = "Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have been developing clinical guidelines to assist practicing clinicians. Objectives The goal of this study was to evaluate changes in ACC/AHA guideline recommendations between 2008 and 2014. Methods The previous and current ACC/AHA guideline documents that were updated between 2008 and June 2014 were compared to determine changes in Class of Recommendation (COR) and Level of Evidence (LOE). Each recommendation was classified as new, dropped, revised, or unchanged, and the changes in evidence were examined. Results During the study period, 11 guideline documents (9 disease based and 2 interventional procedure based) were updated. The total number of recommendations decreased from 2,067 to 1,869 (321 fewer recommendations in disease-based guidelines and 123 additional recommendations in interventional procedure-based guidelines). The recommendation class distribution of the updated guidelines was 50.1{\%} Class I (previously 50.8{\%}), 39.4{\%} Class II (previously 35.4{\%}), and 10.4{\%} Class III (previously 13.8{\%}) (p = 0.001). The LOE distribution among updated versions was 15.0{\%} for LOE: A (previously 13.3{\%}), 50.8{\%} for LOE: B (previously 41.4{\%}), and 34.2{\%} for LOE C (previously 45.3{\%}) (p < 0.001). Among all guidelines, 859 recommendations were new, 1,339 were dropped, 881 were unchanged in COR and LOE, and 129 were revised. Of the revised guidelines, 75 recommendations had an increase in LOE (the majority from LOE: C to LOE: B); 34 recommendations had a decrease in LOE; and 20 recommendations had class changes. LOE increases were justified by introduction of new randomized controlled trials, new studies, and new meta-analyses. Conclusions The ACC/AHA guideline recommendations are undergoing significant changes, becoming more evidence based and scientifically robust with a tendency to exclude recommendations with insufficient scientific evidence.",
keywords = "cardiovascular diseases, clinical guidelines, evolution, scientific evidence",
author = "Henry Han and Howard Chao and Andres Guerra and Alan Sosa and Georgios Christopoulos and Christakopoulos, {Georgios E.} and Rangan, {Bavana V.} and Spyros Maragkoudakis and Hani Jneid and Subhash Banerjee and Brilakis, {Emmanouil S.}",
year = "2015",
month = "6",
day = "30",
doi = "10.1016/j.jacc.2015.04.050",
language = "English (US)",
volume = "65",
pages = "2726--2734",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "25",

}

TY - JOUR

T1 - Evolution of the American College of Cardiology/American Heart Association Clinical Guidelines

AU - Han, Henry

AU - Chao, Howard

AU - Guerra, Andres

AU - Sosa, Alan

AU - Christopoulos, Georgios

AU - Christakopoulos, Georgios E.

AU - Rangan, Bavana V.

AU - Maragkoudakis, Spyros

AU - Jneid, Hani

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2015/6/30

Y1 - 2015/6/30

N2 - Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have been developing clinical guidelines to assist practicing clinicians. Objectives The goal of this study was to evaluate changes in ACC/AHA guideline recommendations between 2008 and 2014. Methods The previous and current ACC/AHA guideline documents that were updated between 2008 and June 2014 were compared to determine changes in Class of Recommendation (COR) and Level of Evidence (LOE). Each recommendation was classified as new, dropped, revised, or unchanged, and the changes in evidence were examined. Results During the study period, 11 guideline documents (9 disease based and 2 interventional procedure based) were updated. The total number of recommendations decreased from 2,067 to 1,869 (321 fewer recommendations in disease-based guidelines and 123 additional recommendations in interventional procedure-based guidelines). The recommendation class distribution of the updated guidelines was 50.1% Class I (previously 50.8%), 39.4% Class II (previously 35.4%), and 10.4% Class III (previously 13.8%) (p = 0.001). The LOE distribution among updated versions was 15.0% for LOE: A (previously 13.3%), 50.8% for LOE: B (previously 41.4%), and 34.2% for LOE C (previously 45.3%) (p < 0.001). Among all guidelines, 859 recommendations were new, 1,339 were dropped, 881 were unchanged in COR and LOE, and 129 were revised. Of the revised guidelines, 75 recommendations had an increase in LOE (the majority from LOE: C to LOE: B); 34 recommendations had a decrease in LOE; and 20 recommendations had class changes. LOE increases were justified by introduction of new randomized controlled trials, new studies, and new meta-analyses. Conclusions The ACC/AHA guideline recommendations are undergoing significant changes, becoming more evidence based and scientifically robust with a tendency to exclude recommendations with insufficient scientific evidence.

AB - Background The American College of Cardiology (ACC) and the American Heart Association (AHA) have been developing clinical guidelines to assist practicing clinicians. Objectives The goal of this study was to evaluate changes in ACC/AHA guideline recommendations between 2008 and 2014. Methods The previous and current ACC/AHA guideline documents that were updated between 2008 and June 2014 were compared to determine changes in Class of Recommendation (COR) and Level of Evidence (LOE). Each recommendation was classified as new, dropped, revised, or unchanged, and the changes in evidence were examined. Results During the study period, 11 guideline documents (9 disease based and 2 interventional procedure based) were updated. The total number of recommendations decreased from 2,067 to 1,869 (321 fewer recommendations in disease-based guidelines and 123 additional recommendations in interventional procedure-based guidelines). The recommendation class distribution of the updated guidelines was 50.1% Class I (previously 50.8%), 39.4% Class II (previously 35.4%), and 10.4% Class III (previously 13.8%) (p = 0.001). The LOE distribution among updated versions was 15.0% for LOE: A (previously 13.3%), 50.8% for LOE: B (previously 41.4%), and 34.2% for LOE C (previously 45.3%) (p < 0.001). Among all guidelines, 859 recommendations were new, 1,339 were dropped, 881 were unchanged in COR and LOE, and 129 were revised. Of the revised guidelines, 75 recommendations had an increase in LOE (the majority from LOE: C to LOE: B); 34 recommendations had a decrease in LOE; and 20 recommendations had class changes. LOE increases were justified by introduction of new randomized controlled trials, new studies, and new meta-analyses. Conclusions The ACC/AHA guideline recommendations are undergoing significant changes, becoming more evidence based and scientifically robust with a tendency to exclude recommendations with insufficient scientific evidence.

KW - cardiovascular diseases

KW - clinical guidelines

KW - evolution

KW - scientific evidence

UR - http://www.scopus.com/inward/record.url?scp=84937459277&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937459277&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2015.04.050

DO - 10.1016/j.jacc.2015.04.050

M3 - Article

C2 - 26112197

AN - SCOPUS:84937459277

VL - 65

SP - 2726

EP - 2734

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 25

ER -