ANALYZING ESC GUIDELINES (GL) OF ARTERIAL HYPERTENSION, MYOCARDIAL REVASCULARIZATION, SYNCOPE AND PREGNANCY FOR DECISION MAKING EFFICACY: THE WINNER IS ARTERIAL HYPERTENSION GL

Abstract

Objective: Guidelines (GLs) for medical practice are essential collection of knowledge, helping the daily clinical decision making in specific health conditions. Accordingly, the European Society of Cardiology (ESC) also develops and publishes GLs. We hypothesized that not every GL of ESC is equally efficient in decision making due to the lack of sufficient evidence. Design and method: Design: Exploratory data analysis. Methods: A total of 636 levels of evidence (LEVEL) of and classes of recommendations (CLASS) data were processed on four ESC GLs – Arterial Hypertension (AH), Myocardial Revascularization (MR), Syncope (S) and Pregnancy (P). Results: Results: The frequency distributions of LEVEL by CLASS showed that AH had the highest rate of Evidence A in each class of recommendations. However, the percent of Evidence A was under 50% on ‘to do’ and ‘not to do’ classes. MR showed a similar frequency distribution than AH, but the frequency of Evidence A was only 36.4% on ‘to do’ and 25.0% on ‘not to do’ classes. In S and P, the percent of Evidence B and/or C was the highest in each class of recommendations. Percent of uncertainty was between 24.3% (AH) and 75.5% (P). The deviation of LEVEL from an optimal decision making revealed that the observed percentages were significantly lower in Evidence A than the expected percentages in the studied GLs. Thus Arterial Hypertension GL provided the highest level of Certainty, whereas Pregnancy GL the highest level of Uncertainty. Conclusions: Conclusions: There is a great disparity of certainty among the four ESC GLs. To ensure the relevant level of Certainty, our findings recommend to reveal the ratio of certainty and uncertainty in the GLs, and to increase the level of strong evidence by conducting new basic science experimental studies and clinical investigations, such as multiple randomized clinical trials or meta-analyses.