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ME/CFS since 1995; activity level 6?
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I wonder what the figures are for other illnesses...?
This is from May-June 2014 - hope I'm not duplicating.
http://www.jwatch.org/na34765/2014/06/05/how-durable-are-strong-recommendations-made-practice
This is from May-June 2014 - hope I'm not duplicating.
http://www.jwatch.org/na34765/2014/06/05/how-durable-are-strong-recommendations-made-practice
June 5, 2014
How Durable Are the Strong Recommendations Made in Practice Guidelines?
Harlan M. Krumholz, MD, SM reviewing Neuman MD et al. JAMA 2014 May 28.
Many Class I recommendations don't survive to the 10-year mark — especially those based merely on opinion or observational data.
Class I recommendations proclaim which practices should be followed in given clinical situations, and they are the strongest made within the American College of Cardiology/American Heart Association guideline framework. Investigators assessed the durability of Class I recommendations to provide a perspective on how often actions that are deemed mandatory become less enthusiastically endorsed as more evidence emerges.
Of 619 Class I recommendations in 11 index guidelines published between 1998 and 2007, 20% of the recommendations did not appear in the subsequent guideline and 9.2% were downgraded or reversed. Even among the recommendations that were supported by multiple trials, 5.7% were not retained in subsequent versions of guidelines and 3.8% were downgraded or reversed. The Class I recommendations at the highest risk for being omitted, downgraded, or reversed were those based on consensus opinion, followed by those based on a single randomized trial or nonrandomized trials.
Comment
I would have thought that the strongest recommendations in a guideline would be very unlikely to change over time. In this disturbing study, a substantial proportion of Class I recommendations were not durable over even a 10-year period, showing us that uncertainty surrounds even the strongest guideline recommendations. I wonder whether the writing committees would have been able to predict which of the Class I recommendations were most likely to be omitted, downgraded, or reversed based on future studies. I'd bet they could not have guessed correctly.
Citation(s):
- Neuman MD et al. Durability of class I American College of Cardiology/American Heart Association clinical practice guideline recommendations. JAMA 2014 May 28; 311:2092. (http://dx.doi.org/10.1001/jama.2014.4949)
CrossRefPubMed abstract (Free)
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