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.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告 2019 概要. 中国循环杂志, 2020, 35(9): 833-854.
4.	陈耀龙, 刘萧, 王燕平, 等. 西医指南与中医药指南: 在相互学习中共同提高. 协和医学杂志, 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.	陈耀龙, 罗旭飞, 王吉耀, 等. 如何区分临床实践指南与专家共识. 协和医学杂志, 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, 张菀桐, 杨巧宁, 等. 中国糖尿病足诊疗指南的方法学质量评价. 中国循证医学杂志, 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, Mörike 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.	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南 2018. 中华心血管病杂志, 2018, 46(10): 760-789.
22.	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性心力衰竭基层诊疗指南(2019 年). 中华全科医师杂志, 2019, 18(10): 936-947.
23.	冠心病中医临床研究联盟, 中国中西医结合学会心血管疾病专业委员会, 中华中医药学会心病分会, 等. 慢性心力衰竭中医诊疗专家共识. 中医杂志, 2014, 55(14): 1258-1260.
24.	陈可冀, 吴宗贵, 朱明军, 等. 慢性心力衰竭中西医结合诊疗专家共识. 中国中西医结合杂志, 2016, 36(2): 133-141.
25.	廖玉华, 杨杰孚, 张健, 等. 舒张性心力衰竭诊断和治疗专家共识. 临床心血管病杂志, 2020, 36(1): 1-10.
26.	胡元会, 张文娟, 杨建宇, 等. 中医内科常见病诊疗指南(西医疾病部分)心力衰竭. 中国中医药现代远程教育, 2011, 9(18): 145-147.
27.	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读. 中国循证儿科杂志, 2013, 8(4): 316-319.
28.	胡晶, 陈茹, 谢雁鸣, 等. 科学和规范的改编临床实践指南. 中国循证儿科杂志, 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. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告 2019 概要. 中国循环杂志, 2020, 35(9): 833-854.
4. 陈耀龙, 刘萧, 王燕平, 等. 西医指南与中医药指南: 在相互学习中共同提高. 协和医学杂志, 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. 陈耀龙, 罗旭飞, 王吉耀, 等. 如何区分临床实践指南与专家共识. 协和医学杂志, 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, 张菀桐, 杨巧宁, 等. 中国糖尿病足诊疗指南的方法学质量评价. 中国循证医学杂志, 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, Mörike 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. 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南 2018. 中华心血管病杂志, 2018, 46(10): 760-789.
22. 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性心力衰竭基层诊疗指南(2019 年). 中华全科医师杂志, 2019, 18(10): 936-947.
23. 冠心病中医临床研究联盟, 中国中西医结合学会心血管疾病专业委员会, 中华中医药学会心病分会, 等. 慢性心力衰竭中医诊疗专家共识. 中医杂志, 2014, 55(14): 1258-1260.
24. 陈可冀, 吴宗贵, 朱明军, 等. 慢性心力衰竭中西医结合诊疗专家共识. 中国中西医结合杂志, 2016, 36(2): 133-141.
25. 廖玉华, 杨杰孚, 张健, 等. 舒张性心力衰竭诊断和治疗专家共识. 临床心血管病杂志, 2020, 36(1): 1-10.
26. 胡元会, 张文娟, 杨建宇, 等. 中医内科常见病诊疗指南(西医疾病部分)心力衰竭. 中国中医药现代远程教育, 2011, 9(18): 145-147.
27. 韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读. 中国循证儿科杂志, 2013, 8(4): 316-319.
28. 胡晶, 陈茹, 谢雁鸣, 等. 科学和规范的改编临床实践指南. 中国循证儿科杂志, 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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