Abstract Background In 2009, the National Academy of Medicine (NAM) published standards for developing trustworthy clinical practice guidelines recommending that "Whenever possible guideline development group members should not have conflicts of interest (COIs)… Members with COIs should represent not more than a minority of the guideline development group members. The chair or cochair should not be a person with COIs." Aim of this study was to assess if the standards of the NAM have influenced the development of the heart failure guidelines of the European Society of Cardiology (ESC) published between 2012 and 2023. Methods From the ESC homepage, the declarations of COIs of task force members (TFM) and reviewers of the guidelines for the diagnosis and treatment of acute and chronic heart failure from 2012, 2016, 2021 and the focused update 2023 were retrieved. The number of COIs was assessed for each version of the guideline. Results Regarding the 2012 guidelines, 24/26 TFM (92%) indicated any COI (range 1-36). Overall, 249 COIs were reported (10.4±7.3 per member). 20/26 TFM (77%) received direct personal payments (8.0±6.6 COIs per member, range 1-28). The chairperson declared 8 COIs. Among the reviewers, 32/38 (84%) indicated any COI (8.1±5.9 COIs per reviewer, range 1-29). In 2016, 19/21 TFM (90%) indicated any COI (range 1-35). Overall, 250 COIs were reported (13.2±9.9 per member). 17/21 TFM (81%) received direct personal payments (10.4±7.4 COIs per member, range 1-28). The chairperson declared 33 and the co-chairperson 21 COIs. Among the reviewers, 67/87 (77%) indicated any COI (8.1±7.3 COIs per reviewer, range 1-31). In 2021, 28/31 TFM (90%) indicated any COI (range 2-54). Overall, 391 COIs were reported (14.1±14 per member). 23/31 TFM (74%) received direct personal payments (9.7±7.5 COIs per member, range 1-29). The chairperson declared 5 COIs. Among the reviewers, 91/117 (78%) indicated any COI (4.8±4.3 COIs per reviewer, range 1-20). In the focused update 2023, 26/30 TFM (87%) declared any COI (range 2-66). Overall, 390 COIs were reported (15 ±14.3 per member). 24/30 TFM (80%) received direct personal payments (9.8±9.4 per member, range1-37). The chairperson declared 4 COIs. Among the reviewers, 32/41 (78%) indicated any COI (5.9±4.6 COIs per reviewer, range 1-18). Companies marketing SGLT2 inhibitors were those most frequently reported in the COI declarations of the TFM in 2021 and 2023, with 21/30 TFM (70%) declaring COIs with one (n=8) or two (n=13) of these companies in 2023. Conclusion Despite the recommendations of the NAM, the proportion of TFM and reviewers of the ESC heart failure guidelines with COIs remains high in 2023. The number of COIs of the TFM and direct personal payments to the TFM have increased from 2012 to 2023. Since COIs can influence healthcare decision makers and may consciously or unconsciously influence choices made throughout the guideline development process, the ESC should follow the standards of the NAM.
Schneider et al. (2025) studied this question.