Reassessment of Clinical Practice Guidelines Go Gently Into That Good Night

摘要

Current use of the term guideline has strayed far from the original intent of the Institute of Medicine. Most current articles called "guidelines" are actually expert consensus reports. It is not surprising, then, that the article by Tricoci et aP in this issue of JAMA demonstrates that revisions of the American College of Cardiology (ACQ/American Heart Association (AHA) guidelines have shifted to more class II recommendations (conflicting evidence and/or divergence of opinion about the usefulness/efficacy of a procedure or treatment) and that 48% of the time, these recommendations are based on the lowest level of evidence (level C: expert opinion, case studies, or standards of care). This trend is especially disconcerting given the quantity of cardiovascular scientific literature published during the last decade