TY - JOUR
T1 - Quality of evidence underlying the American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines on the management of atrial fibrillation
AU - Barnett, Adam S.
AU - Lewis, William R.
AU - Field, Michael E.
AU - Fonarow, Gregg C.
AU - Gersh, Bernard J.
AU - Page, Richard L.
AU - Calkins, Hugh
AU - Steinberg, Benjamin A.
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Fonarow provides consulting to Janssen Pharmaceuticals, Medtronic, and St Jude Medical, and he has received personal fees from Janssen Pharmaceuticals and Medtronic. Dr Calkins has received personal fees for serving as a consultant to Medtronic, Abbott Medical, and Boehringer Ingelheim. Dr Steinberg receives research support from Janssen Pharmaceuticals and Boston Scientific, provides consulting to BMS/Pfizer, and receives educational support from Medtronic and Biotronik. Dr Peterson has received personal fees and/or grants from AstraZeneca, Bayer Pharmaceuticals, Janssen Pharmaceuticals, Merck & Co, Regeneron Pharmaceuticals, Sanofi-Aventis, and Valeant Pharmaceuticals. Dr Piccini receives research funding from Agency for Healthcare Research and Quality, ARCA biopharma, Boston Scientific, Gilead Sciences, Janssen Pharmaceuticals, Johnson & Johnson, ResMed, Spectranetics, and St Jude Medical and provides consulting to BMS/Pfizer, GlaxoSmithKline, Janssen Pharmaceuticals, Johnson & Johnson, Medtronic, and Spectranetics. No other disclosures were reported.
Publisher Copyright:
Copyright 2017 American Medical Association. All rights reserved.
PY - 2017/3
Y1 - 2017/3
N2 - IMPORTANCE: The joint American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) guidelines on the management of atrial fibrillation (AF) are used extensively to guide patient care. OBJECTIVE: To describe the evidence base and changes over time in the AHA/ACC/HRS guidelines on AF with respect to the distribution of recommendations across classes of recommendations and levels of evidence. DATA SOURCES: Data from the AHA/ACC/HRS guidelines on AF from 2001, 2006, 2011, and 2014 were abstracted. A total of 437 recommendations were included. DATA EXTRACTION AND SYNTHESIS: The number of recommendations and distribution of classes of recommendation (I, II, and III) and levels of evidence (A, B, and C) were determined for each guideline edition. Changes in recommendation class and level of evidence were analyzed using the 2001 and 2014 guidelines. RESULTS: From 2001 to 2014, the total number of AF recommendations increased from 95 to 113. Numerically, there was a nonsignificant increase in the use of level of evidence B (30.5% to 39.8%; P = .17) and a nonsignificant decrease in the use of level of evidence C (60.0% to 51.3%; P = .21), with limited changes in the use of level A evidence (8.4% to 8.8%; P = .92). In the 2014 guideline document, 10 of 113 (8.8%) recommendations were supported by level of evidence A, whereas 58 of 113 (51.3%) were supported by level of evidence C. Most recommendations were equally split among class I (49/113; 43.4%) and class IIa/IIb (49/113; 43.4%), with the minority (15/113; 13.3%) assigned as class III. Most class I recommendations were supported by level of evidence C (29/49; 59.2%), whereas only 6 of 49 (12.2%) were supported by level of evidence A. No rate control category recommendations were supported by level of evidence A. CONCLUSIONS AND RELEVANCE: Some aspects of the quality of evidence underlying AHA/ACC/HRS AF guidelines have improved over time. However, the use of level of evidence A remains low and has not increased since 2001. These findings highlight the need for focused and pragmatic randomized studies on the clinical management of AF.
AB - IMPORTANCE: The joint American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) guidelines on the management of atrial fibrillation (AF) are used extensively to guide patient care. OBJECTIVE: To describe the evidence base and changes over time in the AHA/ACC/HRS guidelines on AF with respect to the distribution of recommendations across classes of recommendations and levels of evidence. DATA SOURCES: Data from the AHA/ACC/HRS guidelines on AF from 2001, 2006, 2011, and 2014 were abstracted. A total of 437 recommendations were included. DATA EXTRACTION AND SYNTHESIS: The number of recommendations and distribution of classes of recommendation (I, II, and III) and levels of evidence (A, B, and C) were determined for each guideline edition. Changes in recommendation class and level of evidence were analyzed using the 2001 and 2014 guidelines. RESULTS: From 2001 to 2014, the total number of AF recommendations increased from 95 to 113. Numerically, there was a nonsignificant increase in the use of level of evidence B (30.5% to 39.8%; P = .17) and a nonsignificant decrease in the use of level of evidence C (60.0% to 51.3%; P = .21), with limited changes in the use of level A evidence (8.4% to 8.8%; P = .92). In the 2014 guideline document, 10 of 113 (8.8%) recommendations were supported by level of evidence A, whereas 58 of 113 (51.3%) were supported by level of evidence C. Most recommendations were equally split among class I (49/113; 43.4%) and class IIa/IIb (49/113; 43.4%), with the minority (15/113; 13.3%) assigned as class III. Most class I recommendations were supported by level of evidence C (29/49; 59.2%), whereas only 6 of 49 (12.2%) were supported by level of evidence A. No rate control category recommendations were supported by level of evidence A. CONCLUSIONS AND RELEVANCE: Some aspects of the quality of evidence underlying AHA/ACC/HRS AF guidelines have improved over time. However, the use of level of evidence A remains low and has not increased since 2001. These findings highlight the need for focused and pragmatic randomized studies on the clinical management of AF.
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U2 - 10.1001/jamacardio.2016.4936
DO - 10.1001/jamacardio.2016.4936
M3 - Article
C2 - 28002833
AN - SCOPUS:85031400993
VL - 2
SP - 319
EP - 323
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 3
ER -