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. 2021 Feb;27(2):190-197.
doi: 10.1016/j.cardfail.2020.09.473. Epub 2020 Oct 14.

Inclusion of Performance Parameters and Patient Context in the Clinical Practice Guidelines for Heart Failure

Parag Goyal  1 , Ozan Unlu  2 , Peter J Kennel  2 , Ross C Schumacher  3 , Lauren G Gilstrap  4 , Ashok Krishnaswami  5 , Larry A Allen  6 , Mathew S Maurer  7 , Michael W Rich  8 , Anil Makam  9
Affiliations

Inclusion of Performance Parameters and Patient Context in the Clinical Practice Guidelines for Heart Failure

Parag Goyal et al. J Card Fail. 2021 Feb.

Abstract

Background: To facilitate evidence-based medicine (EBM) on an individual level, it may be important for clinical practice guidelines (CPGs) to incorporate the performance parameters of diagnostic studies and therapeutic interventions (such as likelihood ratio and absolute benefit or harm), and to incorporate relevant patient contexts that may influence decision-making. We sought to determine the extent to which heart failure CPGs currently incorporate this information.

Methods: We reviewed the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) 2013 Heart Failure CPG, the 2017 ACCF/AHA/HFSA update, and European Society of Cardiology (ESC) 2016 Heart Failure CPG. We abstracted variables for each CPG recommendation from the following domains: quality of evidence, strength of recommendation, diagnostic and therapeutic performance parameters, and patient context.

Results: We examined 169 recommendations from the ACCF/AHA 2013 CPGs and 2017 update and 187 recommendations from the 2016 ESC CPGs. Performance parameters for diagnostic studies (2013 ACCF/AHA: 13%; 2017 ACCF/AHA/HFSA update: 0%; 2016 ESC: 0%) and therapeutic interventions (2013 ACCF/AHA: 65%; 2017 ACCF/AHA/HFSA update: 64%; 2016 ESC: 16%) were not commonly included in CPGs. Patient context was included in about half of ACCF/AHA recommendations and a quarter of ESC recommendations.

Conclusions: The majority of recommendations from heart failure CPGs lack information on diagnostic and therapeutic performance parameters and patient context. Given the importance of these components to effectively implement EBM, particularly for a heterogeneous heart failure population, innovative strategies are needed to optimize CPGs so they provide comprehensive yet succinct recommendations that can improve population-level outcomes and ensure optimal patient-centered care.

Keywords: Heart failure; decision-making; evidence-based medicine (EBM); practice guidelines.

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Figures

Figure 1:
Figure 1:
Inclusion of performance parameters and patient context into heart failure clinical practice guidelines. Diagnostic performance parameters were rarely included in any of the heart failure clinical practice guidelines. Therapeutic performance parameters and patient context were occasionally included in the ACCF/AHA and ACCF/AHA/HFSA guidelines, and rarely included in the ESC guidelines. Abbreviations: ACCF/AHA- American College of Cardiology Foundation/American Heart Association; ACCF/AHA/HFSA- American College of Cardiology Foundation/American Heart Association/Heart Failure Society of America; ESC- European Society of Cardiology
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