Temporal changes in infective endocarditis guidelines during the last 12 years: High-level evidence needed

TY - JOUR

T1 - Temporal changes in infective endocarditis guidelines during the last 12 years

T2 - High-level evidence needed

AU - Østergaard, Lauge

AU - Valeur, Nana

AU - Bundgaard, Henning

AU - Butt, Jawad H

AU - Ihlemann, Nikolaj

AU - Køber, Lars

AU - Fosbøl, Emil L

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/11

Y1 - 2017/11

N2 - Background Infective endocarditis (IE) is a complex disease necessitating extensive clinical guidelines. The guidelines from the American Heart Association (AHA) and the European Society of Cardiology (ESC) have been markedly extended during the last 12 years. We examined the evidence base for these changes. Methods IE guidelines published by AHA and ESC were reviewed. We categorized and combined guidelines into 3 time periods: (1) 2004 (AHA) and 2005 (ESC), (2) 2007 (AHA) and 2009 (ESC), and (3) 2015 (AHA) and 2015 (ESC). Number of recommendations, classes of recommendations (I, II, or III), and levels of evidence (LOE) (A, B, or C) were assessed and the changes over time. Results From period 1 to period 3, we found a statistically significant increase in total number of IE recommendations from 37 to 253 (P <.01), a 6.8-fold increase. There were a significant decrease in LOE A (from 7 [20.0%] in period 1 to 4 [1.6%] in period 3, P <.0001, a 57% decrease), a nonsignificant decrease in LOE B recommendations (from 17 [48.6%] in period 1 to 115 [45.9%] in period 3, P =.29, a 6.8-fold increase), and a significant increase in LOE C recommendations (from 11 [31.4%] in period 1 to 134 [53.0%] in period 3, P =.02, a 12.2-fold increase). Conclusions The number of IE guideline recommendations has increased 6- to 7-fold during the last decade without a corresponding increase in evidence. These results highlight the strong need for more clinical studies to improve the level of evidence in IE guidelines.

AB - Background Infective endocarditis (IE) is a complex disease necessitating extensive clinical guidelines. The guidelines from the American Heart Association (AHA) and the European Society of Cardiology (ESC) have been markedly extended during the last 12 years. We examined the evidence base for these changes. Methods IE guidelines published by AHA and ESC were reviewed. We categorized and combined guidelines into 3 time periods: (1) 2004 (AHA) and 2005 (ESC), (2) 2007 (AHA) and 2009 (ESC), and (3) 2015 (AHA) and 2015 (ESC). Number of recommendations, classes of recommendations (I, II, or III), and levels of evidence (LOE) (A, B, or C) were assessed and the changes over time. Results From period 1 to period 3, we found a statistically significant increase in total number of IE recommendations from 37 to 253 (P <.01), a 6.8-fold increase. There were a significant decrease in LOE A (from 7 [20.0%] in period 1 to 4 [1.6%] in period 3, P <.0001, a 57% decrease), a nonsignificant decrease in LOE B recommendations (from 17 [48.6%] in period 1 to 115 [45.9%] in period 3, P =.29, a 6.8-fold increase), and a significant increase in LOE C recommendations (from 11 [31.4%] in period 1 to 134 [53.0%] in period 3, P =.02, a 12.2-fold increase). Conclusions The number of IE guideline recommendations has increased 6- to 7-fold during the last decade without a corresponding increase in evidence. These results highlight the strong need for more clinical studies to improve the level of evidence in IE guidelines.

KW - Cardiology/standards

KW - Endocarditis, Bacterial/therapy

KW - Europe

KW - Follow-Up Studies

KW - Forecasting

KW - Practice Guidelines as Topic/standards

KW - Retrospective Studies

KW - Societies, Medical

KW - United States

U2 - 10.1016/j.ahj.2017.07.018

DO - 10.1016/j.ahj.2017.07.018

M3 - Journal article

C2 - 29129257

SN - 0002-8703

VL - 193

SP - 70

EP - 75

JO - American Heart Journal

JF - American Heart Journal

ER -