Key result
Current guidelines on asymptomatic PAD varied in methodological quality, with AGREE scores ranging from 39% to 73%, and provided conflicting recommendations on screening and treatment.
Why the study?
Uncertainties existed regarding the quality of guidelines for asymptomatic peripheral artery disease and evidence was lacking, leading to questions about recommendation consistency.
Systematic Review (n=14)
Current guidelines for asymptomatic PAD vary significantly in methodological quality and provide conflicting recommendations on screening and treatment, indicating a need for better evidence and transparency.
Clinicians should interpret asymptomatic PAD guidelines cautiously amid conflicts and quality shortfalls; challenges their reliability and supports higher-rigor development.
BACKGROUND: Peripheral artery disease (PAD) is often asymptomatic but increases the risk of developing cardiovascular events. Due to the uncertainties regarding the quality of related guidelines and a lack of clear-cut evidence, we performed a systematic review and critical appraisal of these guidelines to evaluate their consistency of the recommendations in asymptomatic PAD population. METHODS: Guidelines in English between January 1st, 2000 to December 31th, 2017 were screened in databases including Medline via PubMed, EMBASE, the G-I-N International Guideline Library, the National Guidelines Clearinghouse, the Canadian Medication Association Infobase and the National Library for Health. Those guidelines containing recommendations on screening and treatment for asymptomatic PAD were included, and three reviewers evaluated the quality of the guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Related recommendations were then fully extracted and compared by two reviewers. RESULTS: Fourteen guidelines were included finally and the AGREE scores ranged from 39 to 73%. Most of included guidelines scored low in Rigor of development and Editorial independence, and only two guidelines (ACCF/AHA, AHA/ACC) reached the standard on Conflict of Interest from Institute of Medicine (IOM). Eight guidelines recommended screening at different strength while the others found insufficient evidence or were against screening. Conflicting recommendations on treatment were found in the target value of the lipid lowering and antiplatelet therapy. The treatment policies in three guidelines (BWG, CEVF, ESC) appeared more aggressive, but they had low transparency between guideline developer and industry or did not reach the standard of IOM. CONCLUSIONS: Current guidelines on asymptomatic PAD varied in the methodological quality and fell short of the standard in the rigor of development and editorial independence. Conflicting recommendations were found both on the screening and treatment. More effort is needed to provide clear-cut evidences with high quality and transparency among guideline developer and industry.
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Chen et al. (2019) conducted a systematic review in Asymptomatic peripheral artery disease (n=14). Clinical practice guidelines was evaluated on Methodological quality (AGREE II scores) and recommendation consistency. Current guidelines on asymptomatic PAD varied in methodological quality, with AGREE scores ranging from 39% to 73%, and provided conflicting recommendations on screening and treatment.
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