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Conflicting recommendations exist among imaging guidelines for detecting asymptomatic CAD
Ferket B. J Am Coll Cardiol. 2011;57:1591–1600.
Blumenthal R. J Am Coll Cardiol. 2011;57:1601-1603.
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Investigators of a new study have found inconsistencies among different guideline recommendations for imaging of asymptomatic coronary artery disease.
The study included guidelines published in English from January 1, 2003 to February 26, 2010. Of the initial 2,415 guidelines identified, only 14 met the inclusion criteria, which required that they contain recommendations on imaging of asymptomatic CAD specifically targeted to prevent a first coronary event, involve apparently healthy persons and were produced on behalf of a national or international medical specialty society. The Appraisal of Guidelines Research and Evaluation (AGREE) instrument was then used to rate the rigor of development.
According to results, 12 of the 14 guidelines contained disclosures of relationships with industry and of them 11 had at least one panel member that reported a relationship. The AGREE score varied among the 14 guidelines, ranging from 21% to 93%.
Overall, eight guidelines either recommended against or found insufficient evidence for testing of asymptomatic CAD. Six recommended imaging patients at intermediate or high CAD risk based on the Framingham risk score, and five either considered or recommended use of CT calcium scoring for this intention, while three did not find sufficient evidence to make a recommendation for CT. Additionally, two guidelines considered cost effectiveness.
In accompanying editorial, Roger S. Blumenthal, MD, and Rani K. Hasan, MD, with the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, stressed that guidelines should be used by clinicians to help navigate issues and challenges in patient care by application of the best available evidence and not as dicta for all care decisions to perfunctorily adhere.
They further wrote that “Given the difficulties inherent in generating robust randomized controlled trial evidence, judicious application of the available evidence from well-executed prospective, observational cohort studies is needed to continue to improve risk prediction and primary prevention of CAD events.”
Disclosures: Drs. Blumenthal and Hasan report no relevant financial disclosures.
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