- One in five cardiology class I clinical practice guidelines published since the late 1990s have been downgraded, reversed, or omitted.
- Point out that after accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was three times greater for recommendations based on opinion or on one trial or observational data versus recommendations based on multiple trials.
- Atrial fibrillation
- Perioperative cardiovascular evaluation
- Cardiac pacemakers and antiarrhythmia devices
- Secondary prevention of coronary artery disease
- Coronary artery bypass graft surgery
- Cardiovascular disease prevention in women
- Heart failure
- Percutaneous coronary intervention
- Chronic stable angina
- Unstable angina and non-ST-segment elevation myocardial infarction
- Valvular heart disease
And to top it up even more have a browse at this post from the KevinMD blog.
As Dr Lowinger says:
"Yet lately the inadequacies with evidence have become more and more glaring to me. Lately it seems to me that we need to start paying better attention to what evidence can’t do — as much as to what it can do. And I wonder if it isn’t time for a better approach in developing and transmitting health information via any channel.
Evidence, for one thing, doesn’t last. It is a fluid beast — forever slithering under our grasp. Recommendations change over time and there seems to be a growing fuzziness around the edges."