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

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Lauge Østergaard1, Nana Valeur2, Henning Bundgaard1

  • 1Heart Centre, Rigshospitalet, Copenhagen, Denmark.

American Heart Journal
|November 14, 2017
PubMed

Insights

The number of infective endocarditis (IE) guideline recommendations has surged without a rise in evidence quality. More clinical studies are crucial to enhance the evidence base for IE guidelines.

Area of Science:

  • Cardiology
  • Clinical Guidelines
  • Evidence-Based Medicine

Background:

  • Infective endocarditis (IE) is a complex cardiovascular disease with evolving clinical management guidelines.
  • The American Heart Association (AHA) and European Society of Cardiology (ESC) have significantly updated their IE guidelines over the past decade.
  • An analysis of the evidence supporting these guideline changes is warranted.

Purpose of the Study:

  • To evaluate the changes in the evidence base supporting infective endocarditis (IE) guidelines from the AHA and ESC over time.
  • To assess the evolution of the number of recommendations and their corresponding levels of evidence (LOE) in IE guidelines.

Main Methods:

  • A systematic review of IE guidelines published by the AHA and ESC was conducted.
  • Guidelines were grouped into three distinct time periods: 2004-2005, 2007-2009, and 2015.
  • The number of recommendations, recommendation classes, and levels of evidence (A, B, C) were analyzed for changes across these periods.

Main Results:

  • The total number of IE recommendations increased significantly, by 6.8-fold, from 37 to 253 between the first and third periods.
  • There was a statistically significant decrease in Level of Evidence A recommendations (from 20.0% to 1.6%) and a significant increase in Level of Evidence C recommendations (from 31.4% to 53.0%).
  • Level of Evidence B recommendations showed a non-significant increase (from 48.6% to 45.9%) despite a 6.8-fold rise in their absolute number.

Conclusions:

  • Infective endocarditis guideline recommendations have expanded substantially over the last decade without a commensurate increase in the quality of supporting evidence.
  • The findings underscore a critical need for more robust clinical research to strengthen the evidence base for IE guidelines.
  • Future guideline development should prioritize studies that yield higher levels of evidence to ensure optimal patient care.
Abstract

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