Adequacy of reporting monitoring regimens of risk factors for cardiovascular disease in clinical guidelines: systematic review

Moschetti, Ivan; Brandt, Daniel; Perera, Rafael; Clarke, Mary; Heneghan, Carl

doi:10.1136/bmj.d1289

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…First, we searched two systematic reviews on CPGs for CVD prevention [ 23 , 38 ] for CPGs discussing a combined, overall, global, total or absolute risk approach (from here on referred to as AR approach) and looked for updated version of these CPGs. Second, we performed our own systematic review to search for CPGs published after May 2009, the time-frame used in the previous studies, by searching the following three CPG-specific databases: the National CPG Clearinghouse ( http://www.guideline.gov ), G-I-N International CPG Library ( http://www.g-i-n.net ) and Trip database ( https://www.tripdatabase.com ).…”

Section: Methodsmentioning

confidence: 99%

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

et al. 2015

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BackgroundClinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent to which CPGs address issues important for older people identified in the literature.MethodsWe searched: 1) two systematic reviews on CPGs for CVD prevention and 2) the National CPG Clearinghouse, G-I-N International CPG Library and Trip databases for CPGs for CVD prevention, hypertension and cholesterol. We conducted our search between April and December 2013. We excluded CPGs for diabetes, chronic kidney disease, HIV, lifestyle, general screening/prevention, and pregnant or pediatric populations. Three authors independently screened citations for inclusion and extracted data. The primary outcomes were presence and extent of recommendations for older people including discussion of: (1) available evidence, (2) barriers to implementation of the CPG, and (3) tailoring management for this group.ResultsWe found 47 eligible CPGs. There was no mention of older people in 4 (9 %) of the CPGs. Benefits were discussed more frequently than harms. Twenty-three CPGs (49 %) discussed evidence about potential benefits and 18 (38 %) discussed potential harms of CVD prevention in older people. Most CPGs addressed one or more barriers to implementation, often as a short statement. Although 27 CPGs (58 %) mentioned tailoring management to the older patient context (e.g. comorbidities), concrete guidance was rare.ConclusionAlthough most CVD prevention CPGs mention the older population to some extent, the information provided is vague and very limited. Older adults represent a growing proportion of the population. Guideline developers must ensure they consider older patients’ needs and provide appropriate advice to clinicians in order to support high quality care for this group. CPGs should at a minimum address the available evidence about CVD prevention for older people, and acknowledge the importance of patient involvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0310-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

et al. 2015

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“…Reviews of guidelines in other areas have shown similar findings regarding the presentation of evidence for recommended schedules for monitoring. 25,26 Reviews of treatment 27 and diagnostic guidelines 28 have identified a similar inconsistency in recommendations between guidelines and variation in the evidence cited, with some referring to a substantial body of evidence and others presenting very little. [29][30][31] Several factors are likely to contribute to our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, Moschetti and colleagues found similar results for monitoring in cardiovascular disease. 26 Our systematic approach to assessing the development and content of the guidelines provides insight into how strategies for monitoring are developed and reported, and we have presented a general picture of the type of evidence that has been cited. The true picture may be worse, given our attempt to attribute citations to recommendations wherever possible.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The basis for monitoring strategies in clinical guidelines: a case study of prostate-specific antigen for monitoring in prostate cancer

Dinnes

Hewison

Altman

et al. 2011

CMAJ

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M onitoring involves the scheduled, repeated use of a test or tests in an individual over time to make decisions about the management of a disease or condition. It is a central activity in the management of care, taking up a considerable part of the clinical workload and associated cost.1 In contrast, the volume of published literature on the evaluation and use of tests for monitoring purposes is relatively sparse.Mant and others have provided a framework for developing and evaluating a monitoring strategy with four main steps:1-3 deciding whether to monitor, choosing a test, specifying and assessing the monitoring strategy to be used, and implementing the strategy. Underlying this framework is the key concept that the "signal" from the test, reflecting the status of the underlying condition, should be greater than the surrounding "noise," or measurement variability, that may affect the interpretation of the results. 2,3If the noise is too high in relation to the signal, one's certainty in a given test result will be considerably reduced.The repeated measurement of prostate -specific antigen among men who have received primary treatment for prostate cancer is an ap parently successful example of a rule-based monitoring strategy. The levels of prostate -specific antigen following radical treatment vary. Recurrence of disease following radical prostatectomy is associated with the presence of prostate-specific antigen; following radical radiotherapy, it is associated with a rise in the level of prostate-specific antigen.4 When a predefined level is reached, biochemical failure is said to have occurred. The usefulness of testing for prostate-specific antigen as a form of monitoring is based on the assumption that biochemical failure predates clinical failure within some clinically meaningful time frame. The decision to initi-

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“…One recent study looked at 117 guidelines with a section on lipids. 9 More than half of these guidelines provided no information on what to monitor, when to monitor and what to do if target was out of range. The absence of this type of guidance may affect implementation.…”

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confidence: 99%

Implementation, target population, compliance and barriers to risk guided therapy

Tokgözoğlu

Bruckert

2012

Eur J Prev Cardiolog

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Early intervention to control cardiovascular disease risk factors can result in significant reductions in cardiovascular disease mortality. However, there is a large gap between risk factor management outlined in clinical guidelines and actual patient care, with preventative medication being underused, particularly in low-income countries. Consequently, cardiovascular disease remains the leading cause of mortality. There are several barriers to guideline implementation. First, clinical trial populations are not representative of the at-risk population as a whole. Patients treated in clinical practice are often older with more co-morbidities, making them more difficult to treat. In addition, adverse effects of medication and complex dosing regimens reduce adherence to therapy. The wide choice of guidelines, lack of awareness of the guidelines and a perception that their recommendations are unrealistic, as well as time constraints on the physician and prescription costs, have also been identified as reasons why guideline recommendations are not followed. Strategies to improve adherence to guideline recommendations include research to better define optimal treatment in different patient populations, increased funding for research and guideline dissemination and implementation programmes, policies promoting healthy lifestyles and preventative medicine and physician and patient education. Systemic monitoring of quality of care and outcomes are also important to identify gaps in guideline implementation that could be addressed. A multidisciplinary team approach to risk factor management and telephone/Internet support systems have been shown to improve compliance with lifestyle changes and pharmacotherapy. Overcoming the barriers to implementation of guideline recommendations is key to improving cardiovascular disease prevention.

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Adequacy of reporting monitoring regimens of risk factors for cardiovascular disease in clinical guidelines: systematic review

Cited by 8 publications

References 19 publications

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

Systematic review of clinical practice guidelines recommendations about primary cardiovascular disease prevention for older adults

The basis for monitoring strategies in clinical guidelines: a case study of prostate-specific antigen for monitoring in prostate cancer

Implementation, target population, compliance and barriers to risk guided therapy

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