Guideline to Guidelines. Implementation of scientific evidence into clinical guidelines

Abstract

Abstract Background: The knowledge and help provided by the medical guidelines are essential to make informed clinical decisions. However, there are no systematic methods to assess the efficacy of guidelines, i.e., how much contribution they provide to informed decisions in various health conditions. Methods: A mathematical analysis was developed to assess the efficacy of guidelines. As an example, the “2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease” (GL-SCE) was analysed/assessed. The analysis was conducted on the Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL). LEVEL areas under CLASS were calculated to form a Certainty Index (CI:–1 to+1). Results: The frequency of CLASS I (‘to do’) and CLASS III (‘not to do’) was relatively high in GL-SCE. Yet, the most frequent LEVEL was C, indicating a low quality of scientific evidence. The GL-SCE showed a relatively high CI (+0.57), 78.4% Certainty and 21.6% Uncertainty. Conclusions: GL-SCE provides a substantial help to decision-making through the recommendations, but the supporting evidence in most CLASS-es has low quality, which is well-reflected in the developed Certainty Index identifying issues that should be clarified and investigated in future studies. We propose that the developed mathematical analysis should be used as a Guideline to Guidelines to assess their efficacy and support their implementation in clinical practice thus providing a ‘quality control’.