Abstract T P316: Are AHA/ASA Stroke Guidelines Evident Enough?
Background and Purpose: Professional society statements and practice guidelines are commonly used in clinical decision-making and to establish benchmarks for quality of care. However a small percentage of recommendations are based on high levels of evidence. We sought to determine temporal trends in the strength of guideline recommendations by comparing the current Level of Evidence and Class of Recommendation assigned to recommendations in current vs. previous American Stroke Association (ASA) Flagship Guidelines.
Methods: We assessed 3 current (2011-2013) ASA practice guidelines for acute stroke, primary prevention and secondary prevention and the prior version (2006-2007) of each guideline. Class (I, IIa, IIb, III) and Level of Evidence (A, B, C) for all recommendations (total of 503) were abstracted. The percentages of recommendations in each of the categories for each guideline were compared between the recent and prior guidelines using a chi-square test.
Results: Comparisons between the Class and Level of Evidence categories for the 3 current and previous flagship guidelines are shown in the table. For the acute stroke guidelines, the number of Class IIb (mostly level B and C) recommendations increased from 2007 to 2013, with a decrease in III recommendations. There were no significant changes in the Class or Level for the primary prevention guidelines from 2007 to 2011. For the secondary prevention guidelines, there was a trend toward an increase in the number of Class I recommendations from 2006 to 2011 and an increase in the number of level B recommendations.
Conclusion: Many of the recommendations in the current stroke guidelines are based on Level B and C Evidence. However, there has been some improvement in the Level of Evidence for secondary prevention guidelines compared to prior versions. Continued assessment of areas of low evidence may help focus future research strategies.
Author Disclosures: S.A. Pawar: None. A. Boan: None. M. Athar: None. T. Turan: Employment; Modest; Significant; salary support NINDS..
- © 2014 by American Heart Association, Inc.