Goal 1: Promote Human Health

Updating level C evidence in Clinical Guidelines

Clinical Guidelines depends on good science. Despite this, only 11% of guidelines that reported level of evidence in 2009, had level of evidence A while 48% had level C. Studies have shown that recommendations based on Level of Evidence C (or their equivalence) are significantly less reliable and may be downgraded, reversed or omitted when better evidence is available.

I propose a comprehensive review of ACC/AHA guideline recommendations for Class 1 and possibly Class 2 recommendations that have Level of evidence of C, followed by a quantification of the potential impact from a guideline recommendation reversal. The resultant list could subsequently be used to guide researchers’ and funding agency priorities for new studies.

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Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Upgrading the level of evidence that recommendations are based on in clinical guidelines, will potentially improve outcomes, reduce unnecessary risk and reduce cost of all aspects of cardiovascular care.

Feasibility and challenges of addressing this CQ or CC :

There are three phases:

1) Review the current published clinical guidelines (and Appropriate Use Criteria) for recommendations relying on level of evidence of C- Very feasible.

2) Ranking impact of clinical recommendations that only have level of evidence C- Quite feasible, but will need to set up a protocol and review committee.

3) Designing and funding high priority studies: Feasible- especially if done under the umbrella of the NHLBI. The challenges will be to set up good studies that supply enough data to be useful in making recommendations based on Level of evidence A in the Guidelines.

Name of idea submitter and other team members who worked on this idea : Gilead Lancaster, MD, Associate Clinical Professor of Medicine, Yale University School of Medicine

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Idea No. 1078