Quality assessment and comparative analysis on the recommendations of current guidelines on screening and diagnosis of peripheral arterial disease: a systematic review

Abstract

ObjectivesThere are several clinical practice guidelines available for peripheral artery disease (PAD). The paucity of strong evidence is known to give room for variations in recommendations across guidelines, with attendant confusion among clinicians in clinical practice. This study aims to conduct a quality assessment and comparative analysis on PAD screening and diagnostic recommendations in PAD management.SelectionClinical practice guidelines written after 2010 and on or before 2020 were targeted. An exhaustive search was conducted through the major medical databases and websites of specialist international organisations of interest, and selection was made using our inclusion/exclusion criteria.SettingGlobal. All guidelines written in English were included in this study.Selected guidelinesNine guidelines were selected.OutcomesThe primary outcomes were the guidelines’ quality and variations in screening and diagnostic recommendations in the selected guidelines.ResultsRegarding quality, the guidelines had the lowest scores across the applicability and stakeholder involvement domains with means (SD) of 62 (9.9) and 65.3 (13), respectively. The highest score was clarity of presentation, with a mean (SD) of 86.8 (5.1). Also, the trend showed guideline quality scores improved over time. The guidelines unanimously offered to screen ‘high-risk’ patients, although there were some discrepancies in the appropriate age range and unavailability of strong evidence backing this recommendation. The guidelines harmoniously adopted the Ankle-Brachial Index as the initial diagnostic investigation of choice. However, concerning further diagnostic investigations and imaging, we found several discrepancies among the recommendations in the absence of strong evidence.ConclusionThough the quality of the guidelines is shown to be improving over time, they perform poorly in stakeholder involvement and applicability domains, which could be influencing interest in research revolving around screening and diagnostic recommendations. Involving primary care providers and the public can be a possible solution.PROSPERO registration numberCRD42020219176.

Documentary analysis of national and international guidance for community clinicians referring patients with suspected chronic limb-threatening ischaemia

“…The AGREE II tool has previously been used to assess guidelines for pharmacological management and screening and diagnosis of PAD. 17 45 but in agreement with our results, found them to score higher in two of the three relevant domains than the NICE guidelines, 26 the American Heart Association/American College of Cardiology (AHA/ACC) guidelines 28 and the ESC guidelines. 18 The only domain where our results did not agree was applicability, where the AHA/ACC guidelines scored higher than the Global Vascular Guidelines.…”

“… 17 45 46 Uyagu et al , Chen et al and Barriocanal et al similarly found guidelines to score poorly in stakeholder involvement and applicability domains compared with clarity of presentation. The Global Vascular Guidelines 29 were only included in Uyagu et al ’s review of screening and diagnosis of PAD, 45 but in agreement with our results, found them to score higher in two of the three relevant domains than the NICE guidelines, 26 the American Heart Association/American College of Cardiology (AHA/ACC) guidelines 28 and the ESC guidelines. 18 The only domain where our results did not agree was applicability, where the AHA/ACC guidelines scored higher than the Global Vascular Guidelines.…”