Practices of low value or unnecessary practices in vascular prevention: Document of the Spanish Interdisciplinary
C Brotons1, I Moral2, J M García Abajo3
1SEMFYC, Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, Spain; Institut de Recerca Sant Pau, Barcelona, Spain; Equipo de Atención Primaria Sardenya, Barcelona, Spain.
Insights
Guidelines increasingly identify low-value care practices in vascular prevention, but significant discrepancies exist between recommendations. This highlights evolving evidence and interpretation differences in cardiovascular care.
Area of Science:
- Cardiology
- Health Policy
- Evidence-Based Medicine
Background:
- Low-value practices are avoidable interventions offering no health benefits.
- Vascular prevention guidelines are crucial for optimizing patient care.
- Identifying and reducing low-value care is essential for healthcare efficiency.
Purpose of the Study:
- To conduct a narrative review of low-value care recommendations in vascular prevention.
- To analyze guidelines from major European and North American scientific societies.
- To identify trends and discrepancies in low-value care recommendations.
Main Methods:
- A narrative review of clinical practice guidelines and consensus documents was performed.
- Publications from 2014 to 2024 from European and North American societies were included.
- Recommendations on low-value care in vascular prevention were systematically extracted and analyzed.
Main Results:
- 38 guidelines were reviewed; 28 contained 141 recommendations on low-value care.
- The American Heart Association issued the most recommendations (39; 27.7%).
- The European Society of Hypertension's hypertension guideline had the most recommendations (20; 14.2%).
Conclusions:
- Guidelines increasingly specify low-value diagnostic or pharmacological activities.
- There is agreement on some recommendations, but clear discrepancies exist.
- Discrepancies may reflect scientific uncertainty and varied interpretation of evidence.
Background:
Low-value practices are avoidable interventions that provide no health benefits. The objective of this study was to conduct a narrative review of the recommendations for practices of low value-care in vascular prevention.
Methods:
A narrative review of all low value-care recommendations for vascular prevention published in the main European and North American scientific societies for clinical practice guidelines between 2014 and 2024 was carried out.
Results:
A total of 38 clinical practice guidelines and consensus documents from international organizations in the United States, Canada, the United Kingdom, and Europe were reviewed, 28 of which included between 1 and 20 recommendations on practices of low value-care in vascular prevention. The total number of recommendations was 141. The American Heart Association is the society that offers the largest number of recommendations of low value-care, with 39 recommendations (27.7%) in 5 clinical practice guidelines (13.2% of the total guidelines with recommendations). The guideline for the management of arterial hypertension of the European Society of Hypertension is the guideline that concentrates the largest number of recommendations of low value-care in a single guideline, with 20 recommendations (14.2% of the total guidelines with recommendations).
Conclusions:
There are more and more guidelines that explicitly describe diagnostic or pharmacological activities of low value-care or Do Not Do Class III or recommendation D. Some guidelines agree, but others show clear discrepancies, which can illustrate the uncertainty of the scientific evidence and the differences in its interpretation.
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