Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yiwen ^1,2 , LIU Yanfei ³ , CUI Jing ¹ , HUANG Luqi ² , CHEN Keyi ¹ ,  LIU Yue ^1,2

1. National Clinical Research Center of Cardiovascular Diseases of Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;
2. China Center for Evidence-Based Medicine of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P.R.China;
3. Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;

Corresponding?author：

LIU Yue, Email: liuyue@188.com

Keywords：

Coronary heart disease; Traditional Chinese medicine; Clinical practice guideline; Quality assessment; AGREE Ⅱ

DOI：

10.7507/1672-2531.202102029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the methodological quality of traditional Chinese medicine (TCM) guidelines and expert consensuses for the diagnosis and treatment of coronary heart diseases (CHD).Methods Databases including PubMed, CNKI, CBM, WanFang Data and the official websites of the China Association of Traditional Chinese Medicine, and the Chinese Association of Integrated Traditional and Western Medicine were electronically searched to collect guidelines (or expert consensus) of TCM for CHD from January 1^st, 2010 to January 1^st, 2021. Methodological evaluation of the included guidelines was conducted by 3 researchers independently using the AGREE Ⅱ instrument.Results A total of 16 guidelines were included. The AGREE Ⅱ scores for each domain were: clarity and presentation (63.89%), followed by scope and purpose (55.90%), stakeholder involvement (42.13%), the rigor of development (41.42%), editorial independence (32.12%), and applicability (21.99%). Nine guidelines were rated as level B (recommended after being revised), and 7 were rated as level C (not recommended).Conclusions Guidelines and expert consensuses of TCM for CHD provide a standard for clinical practice, however, the methodological quality remains to be improved. It is suggested that future guidelines be formulated in accordance with international standards and using the methods of evidence-based medicine to improve the quality of guidelines further and promote international acceptability.

Citation： LI Yiwen, LIU Yanfei, CUI Jing, HUANG Luqi, CHEN Keyi, LIU Yue. Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases. Chinese Journal of Evidence-Based Medicine, 2021, 21(6): 696-702. doi: 10.7507/1672-2531.202102029 Copy

1.	《中國心血管健康與疾病報告》編寫組. 《中國心血管健康與疾病報告2019》要點解讀. 中國心血管雜志, 2020, 25(5): 401-410.
2.	Moran A, Gu D, Zhao D, et al. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes, 2010, 3(3): 243-252.
3.	Duan X, Zhou L, Wu T, et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database Syst Rev, 2008, (1): CD004473.
4.	Mao C, Fu XH, Yuan JQ, et al. Tong-xin-luo capsule for patients with coronary heart disease after percutaneous coronary intervention. Cochrane Database Syst Rev, 2015, (5): CD010237.
5.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
6.	Institute of Medicine. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.
7.	Institute of Medicine. Setting priorities for clinical practice guidelines. Washington, DC: National Academy Press, 1995.
8.	Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: The National Academies Press, 2011.
9.	陳耀龍, 羅旭飛, 王吉耀, 等. 如何區分臨床實踐指南與專家共識. 協和醫學雜志, 2019, 10(4): 403-408.
10.	Appraisal of guidelines for research & evaluation Ⅱ instrument. Available from:http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf.
11.	韋當, 王聰堯, 肖曉娟, 等. 指南研究與評價(AGREEⅡ)工具實例解讀. 中國循證兒科雜志, 2013, 8(4): 316-319.
12.	中國中醫科學院. 中醫循證臨床實踐指南·中醫內科. 北京: 中國中醫藥出版社, 2011.
13.	中華中醫藥學會心血管病分會. 冠心病穩定型心絞痛中醫診療指南. 中醫雜志, 2019, 60(21): 1880-1890.
14.	中華中醫藥學會心血管病分會. 冠心病穩定型心絞痛中醫診療專家共識. 中醫雜志, 2018, 59(5): 447-450.
15.	蔡光先, 顏旭, 寧澤璞, 等. 內科常見疾病中醫證治國際標準(草案)冠心病心絞痛. 湖南中醫雜志, 2010, 26(4): 97-99.
16.	中華中醫藥學會. 胸痹心痛中醫診療指南. 中國中醫藥現代遠程教育, 2011, 9(23): 106-107.
17.	中華中醫藥學會. 中醫內科常見病診療指南(西醫疾病部分)冠心病心絞痛. 中國中醫藥現代遠程教育, 2011, 9(18): 143-145.
18.	中國中醫藥研究促進會中西醫結合心血管病預防與康復專業委員會. 穩定性冠心病中西醫結合康復治療專家共識. 中西醫結合心腦血管病雜志, 2019, 17(3): 321-329.
19.	中國醫師協會中西醫結合醫師分會, 中國中西醫結合學會心血管病專業委員會, 中國中西醫結合學會重癥醫學專業委員會, 等. 急性心肌梗死中西醫結合診療指南. 中國中西醫結合雜志, 2018, 38(3): 272-284.
20.	中國醫師協會中西醫結合醫師分會, 中國中西醫結合學會心血管病專業委員會, 中國中西醫結合學會重癥醫學專業委員會, 等. 急性心肌梗死中西醫結合診療專家共識. 中國中西醫結合雜志, 2014, 34(4): 389-395.
21.	陳可冀, 史大卓. 冠心病及急性心肌梗死中醫臨床辨證標準及防治指南. 北京: 人民衛生出版社, 2014.
22.	Liao PD, Chen KJ, Ge JB, et al. Clinical practice guideline of integrative Chinese and Western medicine for acute myocardial infarction. Chin J Integr Med, 2020, 26(7): 539-551.
23.	中華中醫藥學會心血管病分會. 冠心病心絞痛介入前后中醫診療指南. 中國實驗方劑學雜志, 2018, 24(15): 4-6.
24.	世界中醫藥聯合會心血管病專業委員會, 中國中西醫結合學會心血管病專業委員會, 中華中醫藥學會介入心臟病學會, 等. 冠狀動脈血運重建術后心絞痛中西醫結合診療指南. 中國中西醫結合雜志, 2020, 40(11): 1298-1307.
25.	中華中醫藥學會介入心臟病學專家委員會. 經皮冠狀動脈介入治療(PCI)術后胸痛中醫診療專家共識. 中醫雜志, 2014, 55(13): 1167-1170.
26.	世界中醫藥學會聯合會介入心臟病專業委員會, 中華中醫藥學會介入心臟病專業委員會, 中國中西醫結合學會心血管病專業委員會介入心臟病學組, 等. 經皮冠狀動脈介入治療圍手術期心肌損傷中醫診療專家共識. 中國中西醫結合雜志, 2017, 37(4): 389-393.
27.	國家心血管病中心中西醫結合Ⅰ期心臟康復專家共識委員會. 中西醫結合冠狀動脈旁路移植術Ⅰ期心臟康復專家共識. 中國循環雜志, 2017, 32(4): 314-317.
28.	Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy, 2009, 64(5): 669-677.
29.	Dalen JE, Alpert JS, Goldberg RJ, et al. The epidemic of the 20(th) century: coronary heart disease. Am J Med, 2014, 127(9): 807-812.
30.	Angelis A, Kanavos P. Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework. Soc Sci Med, 2017, 188: 137-156.
31.	Zhao L, Li D, Zheng H, et al. Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med, 2019, 179(10): 1388-1397.
32.	Mao S, Zhang X, Shao B, et al. Baduanjin exercise prevents post-myocardial infarction left ventricular remodeling (BE-PREMIER trial): design and rationale of a pragmatic randomized controlled trial. Cardiovasc Drugs Ther, 2016, 30(3): 315-322.
33.	Salmoirago-Blotcher E, Wayne PM, Dunsiger S, et al. Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc, 2017, 6(10): e006603.
34.	楊衍濤, 鄭明福, 王健健, 等. 中醫藥臨床實踐指南和專家共識引用系統評價/Meta分析現況調查. 中國循證醫學雜志, 2021, 21(1): 83-89.
35.	Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.
36.	張曉雨, 陳詩琪, 李承羽, 等. 循證中醫藥學理論研究與應用實踐. 中國循證醫學雜志, 2018, 18(1): 86-91.
37.	楊穎, 畢穎斐, 王賢良, 等. 基于AGREEⅡ的中醫藥治療心血管病指南/共識質量評價. 中西醫結合心腦血管病雜志, 2020, 18(7): 1030-1038.
38.	劉道踐, 陳俊國, 李源, 等. 一個中國化醫學臨床指南評價工具的研發. 中國醫學裝備, 2012, (9): 11-14.
39.	崔樹起, 梁萬年. 臨床指南實踐手冊. 北京: 人民衛生出版社, 2003.

1. 《中國心血管健康與疾病報告》編寫組. 《中國心血管健康與疾病報告2019》要點解讀. 中國心血管雜志, 2020, 25(5): 401-410.
2. Moran A, Gu D, Zhao D, et al. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes, 2010, 3(3): 243-252.
3. Duan X, Zhou L, Wu T, et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database Syst Rev, 2008, (1): CD004473.
4. Mao C, Fu XH, Yuan JQ, et al. Tong-xin-luo capsule for patients with coronary heart disease after percutaneous coronary intervention. Cochrane Database Syst Rev, 2015, (5): CD010237.
5. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
6. Institute of Medicine. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.
7. Institute of Medicine. Setting priorities for clinical practice guidelines. Washington, DC: National Academy Press, 1995.
8. Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: The National Academies Press, 2011.
9. 陳耀龍, 羅旭飛, 王吉耀, 等. 如何區分臨床實踐指南與專家共識. 協和醫學雜志, 2019, 10(4): 403-408.
10. Appraisal of guidelines for research & evaluation Ⅱ instrument. Available from:http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf.
11. 韋當, 王聰堯, 肖曉娟, 等. 指南研究與評價(AGREEⅡ)工具實例解讀. 中國循證兒科雜志, 2013, 8(4): 316-319.
12. 中國中醫科學院. 中醫循證臨床實踐指南·中醫內科. 北京: 中國中醫藥出版社, 2011.
13. 中華中醫藥學會心血管病分會. 冠心病穩定型心絞痛中醫診療指南. 中醫雜志, 2019, 60(21): 1880-1890.
14. 中華中醫藥學會心血管病分會. 冠心病穩定型心絞痛中醫診療專家共識. 中醫雜志, 2018, 59(5): 447-450.
15. 蔡光先, 顏旭, 寧澤璞, 等. 內科常見疾病中醫證治國際標準(草案)冠心病心絞痛. 湖南中醫雜志, 2010, 26(4): 97-99.
16. 中華中醫藥學會. 胸痹心痛中醫診療指南. 中國中醫藥現代遠程教育, 2011, 9(23): 106-107.
17. 中華中醫藥學會. 中醫內科常見病診療指南(西醫疾病部分)冠心病心絞痛. 中國中醫藥現代遠程教育, 2011, 9(18): 143-145.
18. 中國中醫藥研究促進會中西醫結合心血管病預防與康復專業委員會. 穩定性冠心病中西醫結合康復治療專家共識. 中西醫結合心腦血管病雜志, 2019, 17(3): 321-329.
19. 中國醫師協會中西醫結合醫師分會, 中國中西醫結合學會心血管病專業委員會, 中國中西醫結合學會重癥醫學專業委員會, 等. 急性心肌梗死中西醫結合診療指南. 中國中西醫結合雜志, 2018, 38(3): 272-284.
20. 中國醫師協會中西醫結合醫師分會, 中國中西醫結合學會心血管病專業委員會, 中國中西醫結合學會重癥醫學專業委員會, 等. 急性心肌梗死中西醫結合診療專家共識. 中國中西醫結合雜志, 2014, 34(4): 389-395.
21. 陳可冀, 史大卓. 冠心病及急性心肌梗死中醫臨床辨證標準及防治指南. 北京: 人民衛生出版社, 2014.
22. Liao PD, Chen KJ, Ge JB, et al. Clinical practice guideline of integrative Chinese and Western medicine for acute myocardial infarction. Chin J Integr Med, 2020, 26(7): 539-551.
23. 中華中醫藥學會心血管病分會. 冠心病心絞痛介入前后中醫診療指南. 中國實驗方劑學雜志, 2018, 24(15): 4-6.
24. 世界中醫藥聯合會心血管病專業委員會, 中國中西醫結合學會心血管病專業委員會, 中華中醫藥學會介入心臟病學會, 等. 冠狀動脈血運重建術后心絞痛中西醫結合診療指南. 中國中西醫結合雜志, 2020, 40(11): 1298-1307.
25. 中華中醫藥學會介入心臟病學專家委員會. 經皮冠狀動脈介入治療(PCI)術后胸痛中醫診療專家共識. 中醫雜志, 2014, 55(13): 1167-1170.
26. 世界中醫藥學會聯合會介入心臟病專業委員會, 中華中醫藥學會介入心臟病專業委員會, 中國中西醫結合學會心血管病專業委員會介入心臟病學組, 等. 經皮冠狀動脈介入治療圍手術期心肌損傷中醫診療專家共識. 中國中西醫結合雜志, 2017, 37(4): 389-393.
27. 國家心血管病中心中西醫結合Ⅰ期心臟康復專家共識委員會. 中西醫結合冠狀動脈旁路移植術Ⅰ期心臟康復專家共識. 中國循環雜志, 2017, 32(4): 314-317.
28. Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy, 2009, 64(5): 669-677.
29. Dalen JE, Alpert JS, Goldberg RJ, et al. The epidemic of the 20(th) century: coronary heart disease. Am J Med, 2014, 127(9): 807-812.
30. Angelis A, Kanavos P. Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework. Soc Sci Med, 2017, 188: 137-156.
31. Zhao L, Li D, Zheng H, et al. Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med, 2019, 179(10): 1388-1397.
32. Mao S, Zhang X, Shao B, et al. Baduanjin exercise prevents post-myocardial infarction left ventricular remodeling (BE-PREMIER trial): design and rationale of a pragmatic randomized controlled trial. Cardiovasc Drugs Ther, 2016, 30(3): 315-322.
33. Salmoirago-Blotcher E, Wayne PM, Dunsiger S, et al. Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc, 2017, 6(10): e006603.
34. 楊衍濤, 鄭明福, 王健健, 等. 中醫藥臨床實踐指南和專家共識引用系統評價/Meta分析現況調查. 中國循證醫學雜志, 2021, 21(1): 83-89.
35. Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.
36. 張曉雨, 陳詩琪, 李承羽, 等. 循證中醫藥學理論研究與應用實踐. 中國循證醫學雜志, 2018, 18(1): 86-91.
37. 楊穎, 畢穎斐, 王賢良, 等. 基于AGREEⅡ的中醫藥治療心血管病指南/共識質量評價. 中西醫結合心腦血管病雜志, 2020, 18(7): 1030-1038.
38. 劉道踐, 陳俊國, 李源, 等. 一個中國化醫學臨床指南評價工具的研發. 中國醫學裝備, 2012, (9): 11-14.
39. 崔樹起, 梁萬年. 臨床指南實踐手冊. 北京: 人民衛生出版社, 2003.

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Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases

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