Abstract
BackgroundPeripheral artery disease (PAD) is often asymptomatic but increases the risk of developing cardiovascular events. Due to the uncertainties regarding the quality of related guidelines and a lack of clear-cut evidence, we performed a systematic review and critical appraisal of these guidelines to evaluate their consistency of the recommendations in asymptomatic PAD population.MethodsGuidelines in English between January 1st, 2000 to December 31th, 2017 were screened in databases including Medline via PubMed, EMBASE, the G-I-N International Guideline Library, the National Guidelines Clearinghouse, the Canadian Medication Association Infobase and the National Library for Health. Those guidelines containing recommendations on screening and treatment for asymptomatic PAD were included, and three reviewers evaluated the quality of the guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Related recommendations were then fully extracted and compared by two reviewers.ResultsFourteen guidelines were included finally and the AGREE scores ranged from 39 to 73%. Most of included guidelines scored low in Rigor of development and Editorial independence, and only two guidelines (ACCF/AHA, AHA/ACC) reached the standard on Conflict of Interest from Institute of Medicine (IOM). Eight guidelines recommended screening at different strength while the others found insufficient evidence or were against screening. Conflicting recommendations on treatment were found in the target value of the lipid lowering and antiplatelet therapy. The treatment policies in three guidelines (BWG, CEVF, ESC) appeared more aggressive, but they had low transparency between guideline developer and industry or did not reach the standard of IOM.ConclusionsCurrent guidelines on asymptomatic PAD varied in the methodological quality and fell short of the standard in the rigor of development and editorial independence. Conflicting recommendations were found both on the screening and treatment. More effort is needed to provide clear-cut evidences with high quality and transparency among guideline developer and industry.
Highlights
Peripheral arterial disease (PAD) is defined as an atherosclerotic process that leads to stenosis and occlusion in non-cerebral and non-coronary arteries [1]
Further prevalence data demonstrates that the number of asymptomatic Peripheral artery disease (PAD) patients is several times larger than that of the PAD patients with intermittent claudication [1, 4]
Seven guidelines reported that systematic literature reviews for the evidence base were performed before developing the guidelines [17, 18, 21, 22, 24,25,26]
Summary
Peripheral arterial disease (PAD) is defined as an atherosclerotic process that leads to stenosis and occlusion in non-cerebral and non-coronary arteries [1]. Following coronary heart disease and stroke, PAD has become the third cause of atherosclerotic vascular morbidity [2]. Further prevalence data demonstrates that the number of asymptomatic PAD patients is several times larger than that of the PAD patients with intermittent claudication [1, 4]. Detection and treatment of asymptomatic PAD prevent its progression, and lower the risk of developing cardiovascular events, such as myocardial infarction and stroke. Peripheral artery disease (PAD) is often asymptomatic but increases the risk of developing cardiovascular events. Due to the uncertainties regarding the quality of related guidelines and a lack of clear-cut evidence, we performed a systematic review and critical appraisal of these guidelines to evaluate their consistency of the recommendations in asymptomatic PAD population
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