Rigour of development of European Society of Cardiology, American College of Cardiology and American Heart Association guidelines over a 12-year period (2013-2024): a systematic review of guidelines
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Gomes,Daniel A.;Ahuja,Sanjali A. C.;Yu,Yi Ting;English,Robert;Ahmad,Mahmood;Khanji,Mohammed;Adragão,Pedro;Providência,Rui
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2025
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Article
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INTRODUCTION: The European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) regularly publish guidelines for the management of cardiovascular disease. By definition, a guideline should follow strict methodological criteria, and have a transparent, traceable, and reproducible development process. We aimed to assess the overall strength of the recommendations and rigour of methodological development in ESC and ACC/AHA guidelines. METHODS AND RESULTS: A systematic review of ESC and ACC/AHA guidelines published from 2013 to 2024 was conducted. Documents class of recommendation (COR) and level of evidence (LOE) of recommendations were included. For each document, data regarding citation count (ISI and Scholar), and COR and LOE of the recommendations were extracted. Guidelines were assessed for rigour of methodological development using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Among the 76 included guidelines, the average citation-per-year was 344 (ISI) and 681 (Scholar). Forty-nine per cent of the recommendations were classified as COR I (strong recommendations), while 46% were based solely on expert opinion (LOE C). The overall AGREE II methodology domain score was 29 ± 6 (range 7-56), with the lowest performance for the domains of systematic search of evidence, use of pre-defined criteria for selecting the evidence and external review. Both the strength of the recommendations and rigour of development showed a stable trend over the past 12 years. ACC/AHA guidelines followed more rigorous development methods compared with ESC (AGREE II 36 ± 3 vs. 24 ± 3). CONCLUSIONS: Clinical guidelines from the main European and American cardiovascular societies are highly cited but show significant limitations in methodological rigour.
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European heart journal.Quality of care & clinical outcomes
Volume
11
Issue
6