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Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines
Jared Scott1, Benjamin Howard1, Philip Sinnett1
1Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, 1111 W 17th St, Tulsa, OK 74107, United States.
Insights
The quality of systematic reviews (SRs) supporting ST-elevation myocardial infarction (STEMI) clinical practice guidelines (CPGs) is variable. Key reporting areas like funding and bias assessment need improvement for better CPG development.
Area of Science:
- Cardiology
- Evidence-based Medicine
- Health Research Methodology
Background:
- Systematic reviews (SRs) are crucial for developing evidence-based clinical practice guidelines (CPGs).
- The methodological quality and reporting clarity of SRs underpinning ST-elevation myocardial infarction (STEMI) CPGs require thorough assessment.
- International CPGs for STEMI management were examined for their reliance on SRs.
Purpose of the Study:
- To evaluate the methodological rigor of SRs used in STEMI CPGs.
- To assess the transparency and completeness of reporting in these supporting SRs.
- To identify deficiencies in SR methodology and reporting within STEMI CPGs.
Main Methods:
- Searched 13 guideline clearinghouses for English-language CPGs on STEMI management.
- Extracted 71 unique SRs from the reference lists of included CPGs.
- Assessed SR quality using the Appraisal of tools for systematic reviews (AMSTAR) and PRISMA checklist.
Main Results:
- Four CPGs were included, referencing 71 SRs with AMSTAR scores from 1 to 9.
- SRs consistently showed underperformance in disclosing funding, assessing risk of bias, and publication bias.
- PRISMA checklist completeness varied (44%-96%), with common omissions in search strategy, protocol registration, bias assessment, and funding sources.
Conclusions:
- Significant variability exists in the quality of SRs used for STEMI CPG recommendations.
- Guideline developers are aware of quality variations, but these deficiencies persist and require further attention.
- Improving SR quality and reporting is essential for robust CPG development in STEMI management.
Background:
The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.
Methods:
We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA.
Results:
We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines.
Conclusions:
Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further.
Funding:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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