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Changes over time in US cardiology guidelines

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
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

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):
  1. 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)
 
Last edited:

jimells

Senior Member
Messages
2,009
Location
northern Maine
The Class I recommendations at the highest risk for being omitted, downgraded, or reversed were those based on consensus opinion

They just don't get it. "Consensus" is not scientific, and neither is "opinion"!

Surely doctors are aware of this! This just makes me laugh -- I'm such a cynic

I very much doubt it. They are too busy trying to see 20 patients an hour to do more than mindlessly follow the "guidelines".

In spite of research showing little benefit and a huge list of serious adverse effects, they are still prescribing statins by the truckload. After taking statins for years, my 78-year-old mom was finally forced to stop after she developed a problem with having to pee huge amounts at night. A few weeks later her slowly-developing "dementia" was miraculously cured!

Even for patients with previous stroke or coronary events, over 95% of patients who take statins for five years gained no benefit, while 10% were harmed by muscle damage. This happened to my next-door neighbor. After taking statins for some time, he couldn't lift a can of beer to his lips without pain. And for someone who drinks as much beer as my neighbor, this was a serious adverse effect, for sure!
 

barbc56

Senior Member
Messages
3,657
I'm also a cynic but find this a positive.

As, the author says, new evidence means things need to change.

This is how science works. I think having this published in JAMA, will help these findings translate to medical practice. Health insurance would also/hopefully, take these recommendations when approving cost of treatments treatments.:)

At least in theory.

BARB
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
They just don't get it. "Consensus" is not scientific, and neither is "opinion"!

I very much doubt it. They are too busy trying to see 20 patients an hour to do more than mindlessly follow the "guidelines".

In spite of research showing little benefit and a huge list of serious adverse effects, they are still prescribing statins by the truckload. After taking statins for years, my 78-year-old mom was finally forced to stop after she developed a problem with having to pee huge amounts at night. A few weeks later her slowly-developing "dementia" was miraculously cured!

Even for patients with previous stroke or coronary events, over 95% of patients who take statins for five years gained no benefit, while 10% were harmed by muscle damage. This happened to my next-door neighbor. After taking statins for some time, he couldn't lift a can of beer to his lips without pain. And for someone who drinks as much beer as my neighbor, this was a serious adverse effect, for sure!

If you get the email newsletter Physician's First Watch you will be struck by the number of long-accepted treatments, including surgical ones, that are eventually found to be ineffective.

A recent one is renal denervation :eek: for a type of hypertension. It don't work.