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Guidelines based on multiple randomized studies prove the most durable, US study finds

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3614 (Published 29 May 2014) Cite this as: BMJ 2014;348:g3614
  1. Michael McCarthy
  1. 1Seattle

Guideline recommendations based on a single trial, observational data, expert opinion, or standard of care were three times more likely to be downgraded, reversed, or omitted in subsequent guidelines than those based on multiple randomized trials, a new study published in JAMA has shown.1

In the study researchers looked at changes in class I recommendations in the two most recent versions of 11 guidelines jointly issued by the American Heart Association and the American College of Cardiology. The guidelines included recommendations on issues such as managing atrial fibrillation, chronic stable angina, and heart failure; the use of cardiac pacemakers and anti-arrhythmia devices; and the secondary prevention of coronary artery disease and cardiovascular disease prevention in women.

These guidelines used four …

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