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La mayoría de las directrices cardiovasculares carecen de pruebas sólidas de ensayos controlados aleatorios (ECA). La proporción de recomendaciones de nivel de evidencia A no ha mejorado significativamente en los últimos años para las principales directrices de la sociedad.

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Área de la Ciencia:

  • Cardiología
  • Orientaciones clínicas
  • La medicina basada en la evidencia

Sus antecedentes:

  • Las decisiones clínicas se basan idealmente en pruebas sólidas de múltiples ensayos controlados aleatorios (ECA).
  • Históricamente, pocas recomendaciones de directrices clínicas se han basado exclusivamente en pruebas de ECA de alto nivel.

Objetivo del estudio:

  • Evaluar el nivel de evidencia (LOE) que respalda las directrices actuales de la sociedad cardiovascular.
  • Analizar los cambios en el LOE para las recomendaciones de las directrices a lo largo del tiempo.

Principales métodos:

  • Se han revisado las directrices actuales del Colegio Americano de Cardiología/Asociación Americana del Corazón (ACC/AHA) y de la Sociedad Europea de Cardiología (ESC) (2008-2018).
  • Recomendaciones clasificadas por LOE: A (ECA de gran tamaño múltiple/único), B (ECA de observación/único), C (opinión de expertos).
  • Comparación de la distribución de LOE en las directrices actuales con sus predecesoras.

Principales resultados:

  • Las directrices actuales de ACC/AHA tenían recomendaciones de LOE A del 8,5%; las directrices de ESC tenían un LOE A del 14,2%.
  • La proporción de recomendaciones de LOE A no aumentó significativamente en comparación con las versiones anteriores de las directrices tanto para ACC/AHA como para ESC.
  • La mayoría de las recomendaciones se clasificaron como LOE B o C, lo que indica la dependencia de la evidencia de nivel inferior.

Conclusiones:

  • Un pequeño porcentaje de las recomendaciones en las principales directrices de la sociedad cardiovascular están respaldadas por pruebas de ECA de alto nivel.
  • Esta dependencia de la evidencia de nivel inferior no ha mejorado sustancialmente entre 2008 y 2018.