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Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making
Allan J Hicks1, Zoe L Carwardine2, Mike J Hallworth3
1School of Medical Science, Griffith University, Southport, Australia.
Insights
Laboratory testing is frequently recommended in cardiovascular disease (CVD) guidelines. This study found that 73% to 94% of CVD guidelines from major authorities advocate for laboratory tests in diagnosis and treatment.
Area of Science:
- Clinical Medicine
- Laboratory Medicine
- Cardiovascular Disease
Background:
- The precise impact of laboratory results on clinical decisions is often unsubstantiated.
- Clinical guidelines represent best-practice evidence for disease management.
- Cardiovascular disease (CVD) is a leading global cause of mortality.
Purpose of the Study:
- To evaluate the proportion of cardiovascular disease (CVD) guidelines that recommend laboratory testing.
- To determine the extent of laboratory medicine's integration into evidence-based CVD care.
Main Methods:
- A systematic review of 101 cardiovascular disease (CVD) guidelines from five major national and international authorities.
- Analysis of guideline content for direct references to laboratory test utilization in diagnosis or follow-up.
Main Results:
- Laboratory testing is recommended in a high percentage of guidelines, ranging from 73% to 94%.
- Renal function and blood count tests were most frequently recommended.
- Lipid, troponin, and natriuretic peptide measurements were also commonly advocated.
Conclusions:
- Laboratory testing plays a significant role in evidence-based cardiovascular disease (CVD) care, as evidenced by guideline recommendations.
- The findings provide an index for assessing the value of laboratory medicine in healthcare.
- A substantial majority of CVD guidelines endorse the use of various laboratory tests.
Introduction:
It is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world's most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing.
Materials And Methods:
Five leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ).
Results:
A total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively.
Conclusions:
This study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.
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