Quality assessment of clinical practice guidelines and expert consensus for chronic heart failure_Chinese Journal of Evidence-Based Medicine

Authors：

JU Chunxiao ^1,3 , ZHANG Yao ^1,3 , LIU Xiaolin ^2,3 , LI Yiwen ^2,5 , LIU Lu ^1,3 , WANG Biqing ^1,3 , MEI Jun ^3,4 , ZHAO Junnan ^3,4 , HUANG Luqi ⁶ ,  LIU Yue ^3,5 ,  XU Fengqin ^3,4

1. Graduate School, Beijing University of Chinese Medicine, Beijing 100029, P.R.China;
2. Graduate School, China Academy of Chinese Medical Sciences, Beijing 100700, P.R.China;
3. Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;
4. Institute of Gerontology, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;
5. National Clinical Research Center for Chinese Medicine Cardiology, Beijing 100091, P.R.China;
6. China Center for Evidence-Based Medicine of Traditional Chinese Medicine, Beijing 100078, P.R.China;

Corresponding?author：

LIU Yue, Email: liuyue@188.com; XU Fengqin, Email: doctorxu@aliyun.com

Keywords：

Chronic heart failure; Guideline; Expert consensus; Methodological quality assessment; AGREE Ⅱ

DOI：

10.7507/1672-2531.202104066

Video：

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Objective To evaluate the methodological quality of clinical practice guidelines and expert consensus of chronic heart failure domestically and abroad.Methods PubMed, EMbase, SinoMed, CNKI, WanFang Data, and VIP databases, and related websites were searched to collect guidelines and expert consensus on chronic heart failure published from January 1^st, 2011 to December 31^st, 2020. Four reviewers evaluated the methodological quality of the guidelines and expert consensus with the AGREE Ⅱ tool after the consistency evaluation training.Results A total of 17 studies were included (consisting of 11 English and 6 Chinese studies). The recommended levels were B level (recommend after modification) for 10 studies and C level (not recommended) for 7 studies. The AGREE Ⅱ standardized mean scores for various fields were 69.61% (scope and purpose), 34.20% (stakeholder involvement), 33.13% (rigor of development), 84.53% (clarity and presentation), 42.40% (applicability), and 37.09% (editorial independence). The methodological quality of English guidelines was generally high (level B for 10 and level C for 1), while all scores of Chinese guidelines or consensus in the 6 fields were mostly lower than the average (level C for 6).Conclusions The guidelines for the diagnosis and treatment of chronic heart failure requires further improvement in terms of stakeholder involvement and rigor of development. It should develop standards and methods to improve the quality for Chinese guidelines and expert consensus to better serve clinical practice.

Citation： JU Chunxiao, ZHANG Yao, LIU Xiaolin, LI Yiwen, LIU Lu, WANG Biqing, MEI Jun, ZHAO Junnan, HUANG Luqi, LIU Yue, XU Fengqin. Quality assessment of clinical practice guidelines and expert consensus for chronic heart failure. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1091-1097. doi: 10.7507/1672-2531.202104066 Copy

1.	Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail, 2020, 22(8): 1342-1356.
2.	Metra M, Teerlink JR. Heart failure. Lancet, 2017, 390(10106): 1981-1995.
3.	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 概要. 中國循環雜志, 2020, 35(9): 833-854.
4.	陳耀龍, 劉蕭, 王燕平, 等. 西醫指南與中醫藥指南: 在相互學習中共同提高. 協和醫學雜志, 2020, 11(5): 615-620.
5.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the american college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6): e137-e161.
6.	Trustworthy IOMU, Guidelines CP. Clinical practice guidelines we can trust. Washington (DC): National Academies Press (US), 2011.
7.	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.
8.	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.
9.	AGREE Next Steps Consortium (2009). The AGREE Ⅱ instrument, 2011. Available at: http://www.agreetrust.org.
10.	代欣玥, 張菀桐, 楊巧寧, 等. 中國糖尿病足診療指南的方法學質量評價. 中國循證醫學雜志, 2021, 21(2): 191-196.
11.	Atherton JJ, Sindone A, De Pasquale CG, et al. National heart foundation of australia and cardiac society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ, 2018, 27(10): 1123-1208.
12.	Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure. Can J Cardiol, 2017, 33(11): 1342-1433.
13.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiol Pol, 2016, 74(10): 1037-1147.
14.	Edelmann F, Knosalla C, M?rike K, et al. Chronic heart failure. Dtsch Arztebl Int, 2018, 115(8): 124-130.
15.	Tsutsui H, Isobe M, Ito H, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version. Circ J, 2019, 83(10): 2084-2184.
16.	Kim MS, Lee JH, Kim EJ, et al. Korean guidelines for diagnosis and management of chronic heart failure. Korean Circ J, 2017, 47(5): 555-643.
17.	Clinical practice guidelines: Management of heart failure 2019. Available at: http://guide.medlive.cn/.
18.	Management of chronic heart failure: A national clinical guideline. Available at: https://www.sign.ac.uk/media/1083/sign147.pdf.
19.	Wang CC, Wu CK, Tsai ML, et al. 2019 Focused update of the guidelines of the Taiwan society of cardiology for the diagnosis and treatment of heart failure. Acta Cardiol Sin, 2019, 35(3): 244-283.
20.	Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the heart failure association of the European society of cardiology. Eur J Heart Fail, 2019, 21(10): 1169-1186.
21.	中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南 2018. 中華心血管病雜志, 2018, 46(10): 760-789.
22.	中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 慢性心力衰竭基層診療指南(2019 年). 中華全科醫師雜志, 2019, 18(10): 936-947.
23.	冠心病中醫臨床研究聯盟, 中國中西醫結合學會心血管疾病專業委員會, 中華中醫藥學會心病分會, 等. 慢性心力衰竭中醫診療專家共識. 中醫雜志, 2014, 55(14): 1258-1260.
24.	陳可冀, 吳宗貴, 朱明軍, 等. 慢性心力衰竭中西醫結合診療專家共識. 中國中西醫結合雜志, 2016, 36(2): 133-141.
25.	廖玉華, 楊杰孚, 張健, 等. 舒張性心力衰竭診斷和治療專家共識. 臨床心血管病雜志, 2020, 36(1): 1-10.
26.	胡元會, 張文娟, 楊建宇, 等. 中醫內科常見病診療指南(西醫疾病部分)心力衰竭. 中國中醫藥現代遠程教育, 2011, 9(18): 145-147.
27.	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.
28.	胡晶, 陳茹, 謝雁鳴, 等. 科學和規范的改編臨床實踐指南. 中國循證兒科雜志, 2012, 7(3): 226-230.
29.	Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ, 1999, 318(7182): 527-530.

1. Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail, 2020, 22(8): 1342-1356.
2. Metra M, Teerlink JR. Heart failure. Lancet, 2017, 390(10106): 1981-1995.
3. 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 概要. 中國循環雜志, 2020, 35(9): 833-854.
4. 陳耀龍, 劉蕭, 王燕平, 等. 西醫指南與中醫藥指南: 在相互學習中共同提高. 協和醫學雜志, 2020, 11(5): 615-620.
5. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the american college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6): e137-e161.
6. Trustworthy IOMU, Guidelines CP. Clinical practice guidelines we can trust. Washington (DC): National Academies Press (US), 2011.
7. 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.
8. 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.
9. AGREE Next Steps Consortium (2009). The AGREE Ⅱ instrument, 2011. Available at: http://www.agreetrust.org.
10. 代欣玥, 張菀桐, 楊巧寧, 等. 中國糖尿病足診療指南的方法學質量評價. 中國循證醫學雜志, 2021, 21(2): 191-196.
11. Atherton JJ, Sindone A, De Pasquale CG, et al. National heart foundation of australia and cardiac society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ, 2018, 27(10): 1123-1208.
12. Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure. Can J Cardiol, 2017, 33(11): 1342-1433.
13. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiol Pol, 2016, 74(10): 1037-1147.
14. Edelmann F, Knosalla C, M?rike K, et al. Chronic heart failure. Dtsch Arztebl Int, 2018, 115(8): 124-130.
15. Tsutsui H, Isobe M, Ito H, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version. Circ J, 2019, 83(10): 2084-2184.
16. Kim MS, Lee JH, Kim EJ, et al. Korean guidelines for diagnosis and management of chronic heart failure. Korean Circ J, 2017, 47(5): 555-643.
17. Clinical practice guidelines: Management of heart failure 2019. Available at: http://guide.medlive.cn/.
18. Management of chronic heart failure: A national clinical guideline. Available at: https://www.sign.ac.uk/media/1083/sign147.pdf.
19. Wang CC, Wu CK, Tsai ML, et al. 2019 Focused update of the guidelines of the Taiwan society of cardiology for the diagnosis and treatment of heart failure. Acta Cardiol Sin, 2019, 35(3): 244-283.
20. Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the heart failure association of the European society of cardiology. Eur J Heart Fail, 2019, 21(10): 1169-1186.
21. 中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南 2018. 中華心血管病雜志, 2018, 46(10): 760-789.
22. 中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 慢性心力衰竭基層診療指南(2019 年). 中華全科醫師雜志, 2019, 18(10): 936-947.
23. 冠心病中醫臨床研究聯盟, 中國中西醫結合學會心血管疾病專業委員會, 中華中醫藥學會心病分會, 等. 慢性心力衰竭中醫診療專家共識. 中醫雜志, 2014, 55(14): 1258-1260.
24. 陳可冀, 吳宗貴, 朱明軍, 等. 慢性心力衰竭中西醫結合診療專家共識. 中國中西醫結合雜志, 2016, 36(2): 133-141.
25. 廖玉華, 楊杰孚, 張健, 等. 舒張性心力衰竭診斷和治療專家共識. 臨床心血管病雜志, 2020, 36(1): 1-10.
26. 胡元會, 張文娟, 楊建宇, 等. 中醫內科常見病診療指南(西醫疾病部分)心力衰竭. 中國中醫藥現代遠程教育, 2011, 9(18): 145-147.
27. 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.
28. 胡晶, 陳茹, 謝雁鳴, 等. 科學和規范的改編臨床實踐指南. 中國循證兒科雜志, 2012, 7(3): 226-230.
29. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ, 1999, 318(7182): 527-530.

Chinese Journal of Evidence-Based Medicine

Quality assessment of clinical practice guidelines and expert consensus for chronic heart failure

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