心血管疾病临床实践指南中对预测模型的建议过于乐观:利用系统文献搜索进行的全球调查
Cheng-Yang Jing1, Le Zhang1, Lin Feng2
1Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
Frontiers in cardiovascular medicine
|November 1, 2024
概括
心血管临床实践指南经常建议具有重大方法缺陷的预测模型. 未来的指导方针应该优先考虑具有强大的质量和外部验证的模型,以获得更好的患者结果.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 临床流行病学 临床流行病学
背景情况:
- 临床实践指南 (CPG) 越来越多地包含多变量临床预测模型.
- 评估这些模型及其支持研究的质量对于可靠的临床决策至关重要.
研究的目的:
- 在心血管CPG中综合预测模型的建议.
- 评估主要研究的方法质量,以支持指导方针推的模型.
主要方法:
- 对心血管CPG进行系统的文献搜索 (2018-2023年).
- 识别CPG与预测模型的建议.
- 使用预测模型风险偏差评估工具 (PROBAST) 的方法质量评估.
主要成果:
- 46个CPG推了57个预测模型,主要用于心血管疾病的预后.
- 大多数推的模型专注于心力衰竭和一般人群.
- 只有40%的初级建模研究具有低偏差风险,主要是由于分析和参与者领域的问题.
结论:
- 心血管CPG可能会高估现有预测模型的质量.
- 预测模型的建议应基于更高的方法严格性.
- 未来的心血管实践需要改进模型质量和外部验证.
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