关于结构性心脏病的指导建议和证据水平的演变和区域差异
Yuxiang Tang1,2, Aijin Xie1,2, Yiming Yan3,4
1National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
iScience
|December 30, 2025
概括
结构性心脏病指南显示了强有力的建议,但往往缺乏高质量的证据. 区域差异仍然存在,这凸显了在制定临床指南方面需要全球合作的需要.
科学领域:
- 心脏病学 心脏病学
- 临床指南 临床指南
- 基于证据的医学基于证据的医学.
背景情况:
- 结构性心脏病 (SHD) 管理已取得显著进展.
- 不同地区的SHD指导方针的特点和演变尚未得到充分理解.
- 评估指南质量和区域差异对于改善患者护理至关重要.
研究的目的:
- 在SHD指南中分析推类和证据水平 (LOE) 的分布.
- 将这些特征与美国心脏病学会/美国心脏协会 (ACC/AHA),欧洲心脏病学会 (ESC) 和中国心血管学会进行比较.
- 评估SHD指南中的证据质量随着时间的推移而发生的变化.
主要方法:
- 从先前和当前的SHD指南中对1867条建议的系统评估.
- 根据类别 (强度) 和证据水平 (LOE A,B,C) 分类推.
- 对ACC/AHA,ESC和中国社会中的指南数据进行比较分析.
主要成果:
- 在目前的指南中,53.2%的建议是强烈的 (I/III类),但只有8.1%的LOE A.最高.
- 观察到区域差异:ACC/AHA指南主要使用LOE B (56.3%),而ESC和中国指南严重依赖LOE C (分别为79.4%和69.5%).
- 纵向分析表明,支持推的证据质量总体上有所改善.
结论:
- 在调整建议的强度与SHD指南中支持证据的质量方面存在着持续的挑战.
- 在证据利用方面存在显著的区域差异,需要国际合作来制定指导方针.
- 在全球范围内提高证据质量和标准化指南开发流程对于最佳的SHD管理至关重要.
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