Correlation between the level of evidence and the class of recommendations concerning the pharmacological aspects of the Guidelines of the European Society of Cardiology. (15th March 2023)

• Record Type: Journal Article
• Authors: Milbradt, Stephan; Eichhorn, Jürg; Fetzner, Ulrich; Fietz, Robin; Gross, Ralph; Jung, Karin; Klement, Margaretha; Konzett, Karin; Larcher, Barbara; Manz, Beat; Mareth, Christian; Schmieder, Eileen; Severgnini, Luciano; Sternbauer, Simon; Wehrli, Martha Rosina Trujillo; Weifenbach, Niels; Saely, Christoph; Drexel, Heinz
• Is Part Of: International journal of cardiology. Volume 375(2023)
• Page Start: 119
• Page End: 123
• Publication Date: 2023-03-15
• Subjects: Cardiology -- Pharmacology -- Guidelines -- Comparison -- LoE -- CoR; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.12.027
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background The reliability of the recommendations affecting the clinical decisions is being continuously weighed in everyday practice (Gershlick, 2018). The objective of our study was to assess the consistency of the evidence behind the recommendations. Methods We narrowed our focus on the pharmacotherapeutic aspects of the most recent 38 European Society of Cardiology guidelines and analyzed the correlation between the level of evidence (LoE) classified as A, B and C and the class of recommendations (CoR) subdivided into I, IIa, IIb and III. Results Contrary to the majority of recommendations based on a LoE C (43, 0%), fewer recommendations were proposed on heavily evidence-supported LoE A (23.8%), which percentage increased with subsequent updates of the guidelines. The most common recommendation was CoR I (44, 9%), while the least common recommendation was CoR III (9, 2%). While a similar share of A (39, 1%) and C (30, 1%) LoE shaped the CoR I nearly half (48, 8%) of the CoR III were based on LoE C. Conversely, the overwhelming majority of the recommendations within the scope of LoE A were indisputably strong and classified as CoR I (73, 7%). Conclusion The pharmacological aspects of the ESC guidelines are predominantly based on LoE C. A greater number of pharmacological recommendations are based on LoE A in comparison to the general ones. Various constraints significantly skew the credibility due to paucity of scientific data. A more nuanced approach is needed, as the guidelines cannot completely substitute the clinical experience and the patient-centered approach in shaping the optimal therapeutic outcome. Highlights: The majority of the pharmacological recommendations is based on LoE C More pharmacological aspects are based on LoE A, contrary to the general ESC ones The overwhelming majority of LoE A recommendations is classified as CoR I Evidence gaps in special cohorts could be mistaken for general lack of confirmation