Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease

Partha Sardar; Jay Giri; Michael R. Jaff; Sahil A. Parikh; Amartya Kundu; Christopher J. White; Saurav Chatterjee; Kevin F. Kennedy; Nihar R. Desai; Omar N. Hyder; Debabrata Mukherjee; Mehdi H. Shishehbor; J. Dawn Abbott; Herbert D. Aronow

doi:10.1161/CIRCINTERVENTIONS.118.007244

Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease

Partha Sardar, Jay Giri, Michael R. Jaff, Sahil A. Parikh, Amartya Kundu, Christopher J. White, Saurav Chatterjee, Kevin F. Kennedy, Nihar R. Desai, Omar N. Hyder, Debabrata Mukherjee, Mehdi H. Shishehbor, J. Dawn Abbott, Herbert D. Aronow

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/ deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.

Original language	English
Article number	e007244
Journal	Circulation: Cardiovascular Interventions
Volume	12
Issue number	1
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.118.007244
State	Published - 2019

Bibliographical note

Publisher Copyright:
© 2018 American Heart Association, Inc.

Funding

M. Jaff discloses the following relationships—Noncompensated advisor: Abbott Vascular; Boston Scientific; Cordis, a Cardinal Health Company; Medtronic. Consultant: Micell; Philips/Volcano; Silk Road Medical; Vactronix; Venarum. Equity Investor: PQ Bypass; Gemini; Embolitech; Primacea; Sano V; Vascular Therapies. Dr Parikh serves on the medical advisory board for Abbott Vascular, Boston Scientific, Medtronic, Philips and Cardiovascular Systems, Inc. He receives research funding from TriReme Medical, Shockwave Medical, and Surmodics. He also serves on the speakers bureau or consultant for Siemens, Heartflow, Terumo, and Meril Lifesciences. Dr Giri is a board of Directors, Pulmonary Embolism Response Team (PERT) Consortium, a 501c3 not-for-profit organization; Clinical Events Committee, BEST-CLI trial (Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia) sponsored by National Institutes of Health. Dr Shishehbor, is a consultant and global advisory board member for Medtronic, Abbott Vascular, Philips, Terumo, and Boston Scientific. Dr Abbott is a consultant (clinical trial adjudication) for Recor. The other authors report no conflicts.

Funders	Funder number
Shockwave Medical
Surmodics Incorporated
TriReme Medical

Keywords

American Heart Association
Pulmonary embolism
Stroke
Vena cava filters
Venous thrombosis

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1161/CIRCINTERVENTIONS.118.007244

Cite this

Sardar, P., Giri, J., Jaff, M. R., Parikh, S. A., Kundu, A., White, C. J., Chatterjee, S., Kennedy, K. F., Desai, N. R., Hyder, O. N., Mukherjee, D., Shishehbor, M. H., Dawn Abbott, J., & Aronow, H. D. (2019). Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease. Circulation: Cardiovascular Interventions, 12(1), Article e007244. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007244

@article{de8692a4cef7413fa7f268e50bc9c2d9,

title = "Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease",

abstract = "BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13\% were supported by LOE A and 39\% were supported by LOE C. Overall, most recommendations were class II (54\%), while 35\% were class I. Lower LOEs were observed for interventions for pulmonary embolism/ deep vein thrombosis (A 0\%, B 24\%, C 76\%), inferior vena cava filter (A 0\%, B 31\%, C 69\%), and renal artery stenosis (A 0\%, B 67\%, C 33\%). Comparatively higher LOE A was observed for endovascular stroke therapy (24\%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.",

keywords = "American Heart Association, Pulmonary embolism, Stroke, Vena cava filters, Venous thrombosis",

author = "Partha Sardar and Jay Giri and Jaff, \{Michael R.\} and Parikh, \{Sahil A.\} and Amartya Kundu and White, \{Christopher J.\} and Saurav Chatterjee and Kennedy, \{Kevin F.\} and Desai, \{Nihar R.\} and Hyder, \{Omar N.\} and Debabrata Mukherjee and Shishehbor, \{Mehdi H.\} and \{Dawn Abbott\}, J. and Aronow, \{Herbert D.\}",

note = "Publisher Copyright: {\textcopyright} 2018 American Heart Association, Inc.",

year = "2019",

doi = "10.1161/CIRCINTERVENTIONS.118.007244",

language = "English",

volume = "12",

number = "1",

}

Sardar, P, Giri, J, Jaff, MR, Parikh, SA, Kundu, A, White, CJ, Chatterjee, S, Kennedy, KF, Desai, NR, Hyder, ON, Mukherjee, D, Shishehbor, MH, Dawn Abbott, J & Aronow, HD 2019, 'Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease', Circulation: Cardiovascular Interventions, vol. 12, no. 1, e007244. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007244

Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease. / Sardar, Partha; Giri, Jay; Jaff, Michael R. et al.
In: Circulation: Cardiovascular Interventions, Vol. 12, No. 1, e007244, 2019.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease

AU - Sardar, Partha

AU - Giri, Jay

AU - Jaff, Michael R.

AU - Parikh, Sahil A.

AU - Kundu, Amartya

AU - White, Christopher J.

AU - Chatterjee, Saurav

AU - Kennedy, Kevin F.

AU - Desai, Nihar R.

AU - Hyder, Omar N.

AU - Mukherjee, Debabrata

AU - Shishehbor, Mehdi H.

AU - Dawn Abbott, J.

AU - Aronow, Herbert D.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/ deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.

AB - BACKGROUND: The objective of this study was to evaluate the evidence-base supporting the American Heart Association and American College of Cardiology guidelines on peripheral vascular interventions. METHODS AND RESULTS: American Heart Association/American College of Cardiology guideline documents available as of May 2018 were abstracted for both endovascular and surgical peripheral vascular intervention. The number of recommendations, class of recommendations (I, II, and III) and the distribution of their respective level of evidence (LOE; A, B, and C) were determined for each procedure. Guidelines were also evaluated for changes in recommendations over time. Of 5 current guidelines reporting 134 recommendations, only 13% were supported by LOE A and 39% were supported by LOE C. Overall, most recommendations were class II (54%), while 35% were class I. Lower LOEs were observed for interventions for pulmonary embolism/ deep vein thrombosis (A 0%, B 24%, C 76%), inferior vena cava filter (A 0%, B 31%, C 69%), and renal artery stenosis (A 0%, B 67%, C 33%). Comparatively higher LOE A was observed for endovascular stroke therapy (24%). Compared with previous versions, total number of recommendations for lower extremity peripheral artery disease in the current guideline, decreased from 49 to 26, without an improvement in high-quality evidence. CONCLUSIONS: There is significant variation in the LOE supporting various peripheral vascular intervention in the current American Heart Association/American College of Cardiology guidelines. Overall, the availability of high-quality evidence remains low and the LOE appears insufficient to support many guideline recommendations for peripheral vascular intervention. These findings highlight the need for more objective and comparative evidence to support the use of endovascular and surgical therapy and in some areas, for updated guidelines.

KW - American Heart Association

KW - Pulmonary embolism

KW - Stroke

KW - Vena cava filters

KW - Venous thrombosis

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DO - 10.1161/CIRCINTERVENTIONS.118.007244

M3 - Article

C2 - 30608884

AN - SCOPUS:85059503080

SN - 1941-7640

VL - 12

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 1

M1 - e007244

ER -

Strength of evidence underlying the American Heart Association/American College of Cardiology guidelines on endovascular and surgical treatment of peripheral vascular disease

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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