目的:本研究旨在确定支持心力衰竭(HF)和其他欧洲心脏病学会指南建议的治疗干预措施的证据水平(LoE)是否随时间发生变化。
结果:我们选择的主题至少在2008年至2022年4月之间发布了三个文档。随着时间的推移,收集并比较了与每个文件中治疗干预措施相关的建议(CoR)和支持LoE的类别。分析中包括了18个文件中关于6个主题的1822项建议[每个文件的中位数=112,867(48%)CoRI]。随着时间的推移,HF中CoRI的百分比呈下降趋势(46-36-34%),非ST段抬高型心肌梗死(NSTEMI;78-58-54%),和肺栓塞(PE;65-50-39%)指南,仅HF的建议总数减少。随着时间的推移,瓣膜性心脏病(VHD)和心房颤动(AF)的CoRI百分比稳定在40%左右,约60%用于心血管预防(CVP),VHD和CVP的建议总数增加,AF的建议总数减少。在CoRI中,319(37%)得到LoEA的支持,随着时间的推移,HF(56-46-42%),NSTEMI(29-38-48%)和AF(28-31-36%)增加,PE和CVP的双峰分布,缺乏VHD。
结论:当前欧洲指南中支持治疗建议的LoE普遍较低。医生应该意识到这些局限性,科学学会促进对其意义的更多理解,并推动未来的研究方向。
OBJECTIVE: This study aimed to determine whether any change occurred over time in level of evidence (LoE) of therapeutic interventions supporting heart failure (HF) and other European Society of Cardiology
guideline recommendations.
RESULTS: We selected topics with at least three documents released between 2008 and April 2022. Classes of recommendations (CoR) and supporting LoE related to therapeutic interventions within each document were collected and compared over time. A total of 1822 recommendations from 18 documents on 6 topics [median number per document = 112, 867 (48%) CoR I] were included in the analysis. There was a trend towards a reduction over time in the percentage of CoR I in HF (46-36-34%), non-ST elevation myocardial infarction (NSTEMI; 78-58-54%), and pulmonary embolism (PE; 65-50-39%)
guidelines, with a decrease in the total number of recommendations for HF only. Percentage of CoR I was stable over time around 40% for valvular heart disease (VHD) and atrial fibrillation (AF), and around 60% for cardiovascular prevention (CVP), with an increase in the total number of recommendations for VHD and CVP and a decrease for AF. Among CoR I, 319 (37%) were supported by LoE A, with a decrease over time for HF (56-46-42%), an increase for NSTEMI (29-38-48%) and AF (28-31-36%), a bimodal distribution for PE and CVP, and a lack for VHD.
CONCLUSIONS: LoE supporting therapeutic recommendations in contemporary European
guidelines is generally low. Physicians should be aware of these limitations, and scientific societies promote a greater understanding of their significance and drive future research directions.