支持中国心血管疾病临床实践指南的证据水平及其在过去二十年中的演变
Chen Li1,2, Chuangshi Wang3, Jun Hao3
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China.
The Lancet regional health. Western Pacific
|August 7, 2023
概括
中国心血管疾病 (CVD) 准则显示,缺乏支持强有力的建议的高层证据. 尽管取得了一些改进,但仍需要更多高质量的研究来推进基于证据的实践.
科学领域:
- 心脏病学 心脏病学
- 基于证据的医学基于证据的医学.
- 卫生政策 卫生政策
背景情况:
- 临床实践依赖于改善医疗保健质量的指导方针.
- 评估指南中建议强度和证据质量之间的一致性对于理解医疗实践演变至关重要.
- 这项研究重点关注中国心血管疾病 (CVD) 准则.
研究的目的:
- 评估中国心血管疾病指南中不同类别的建议 (COR) 的证据水平 (LOE).
- 分析随着时间的推移 (2003-2021年) COR-LOE调整的变化.
主要方法:
- 从SinoMed和Wanfang Med在线数据库系统地检索中国心血管指南文件.
- 对79条指导方针进行选和抽象,共计5195条建议,指定了COR和LOE.
- 对COR-LOE比例的分析以及多个版本的指南的变化.
主要成果:
- 在2011-2021年期间的3325条建议中,22.1%是LOE A,38.5%是LOE B,39.4%是LOE C.
- 只有17.9%的建议是I-LOE A类,占I类建议的一小部分.
- 尽管总推增加了,但I-LOE A类推的比例并没有随着时间的推移显著改善.
结论:
- 目前的中国心血管疾病指南显示,支持强有力的建议的高层证据缺乏.
- 虽然一些领域表现出温和的进展,但I-LOE A类推的总体较低比例凸显了需要更多高质量的研究,特别是RCT的需求.
- 将研究成果转化为临床实践仍然是必不可少的,特别是对于未得到充分解决的心血管疾病领域.
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