Assessing the efficacy of the ESC 2025 guidelines for the management of cardiovascular disease and pregnancy

OBJECTIVES: Human Pregnancy-related Cardiovascular Diseases (CVDs) are unique and difficult to study because of many unknown, potentially harmful effects of medical interventions on the fetus. Because of that, there are only sparse data and mechanisms available, which could provide recommendations with strong evidence for physicians. STUDY DESIGN: To assess the efficacy of the European Society of Cardiology (ESC) 2025 Guidelines for the management of cardiovascular disease and Pregnancy (Pregnancy-GL-2025), we used a previously developed mathematical analytic method. MAIN OUTCOME MEASURES: A total of 208 Recommendations and Evidence were analyzed, of which 161 Recommendations concern certain CVD. To assess the efficacy, the Certainty/Uncertainty ratio and the Certainty Index (CI, ranging from -1 to +1) were calculated. RESULTS: In total, the Pregnancy-GL-2025 showed 64.4% of the Class I and III Recommendations (CVDs, 62.7%). The ESC Pregnancy-GL-2025 includes mostly Evidence C (89.4%) and showed 78.8% Certainty (CI = 0.58). Although it includes only a few higher-quality Evidence, these are related to the Class I Recommendations, resulting in a high level of Certainty. CONCLUSIONS: The mathematical analysis of the ESC Pregnancy-GL-2025 showed that it has several helpful Recommendations, yet they are supported primarily by Evidence C. However, because of a few higher-quality evidence related to Class I Recommendations, the overall efficacy of the guideline was relatively high. In addition, the mathematical analysis used instead of frequency analyses does not imply a lower efficacy of a guideline. Thus, we propose that this type of evaluation of guidelines, as a complementary quantitative approach to describing guidelines' recommendations, can facilitate the development of new guidelines.