Partha Sardar1, Jay Giri2,3, Michael R Jaff4, Sahil A Parikh5, Amartya Kundu6, Christopher J White7, Saurav Chatterjee8, Kevin F Kennedy9, Nihar R Desai10, Omar N Hyder1, Debabrata Mukherjee11, Mehdi H Shishehbor12, J Dawn Abbott1, Herbert D Aronow1. 1. Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.). 2. Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia (J.G.). 3. Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia (J.G.). 4. Department of Medicine, Newton-Wellesley Hospital, Newton, MA (M.R.J.). 5. Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York Presbyterian Hospital (S.A.P.). 6. Cardiovascular Medicine, University of Massachusetts Medical School, Worcester (A.K.). 7. Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinical School of the University of Queensland, Ochsner Medical Center, New Orleans, LA (C.J.W.). 8. Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford (S.C.). 9. Division of Cardiology, Mid America Heart and Vascular Institute, Saint Luke's Hospital, Kansas City, MO (K.F.K.). 10. Division of Cardiology, Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, CT (N.R.D.). 11. Texas Tech University Health Sciences Center, El Paso (D.M.). 12. Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.H.S.).
Abstract
BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.
BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.
Authors: Simcha Weissman; Muhammad Aziz; Matthew R Baniqued; Vikas Taneja; Mohammed El-Dallal; Wade Lee-Smith; Sameh Elias; Joseph D Feuerstein Journal: Endosc Int Open Date: 2022-06-10