Lifespan of COVID-19 living guideline recommendations: a survival analysis

Abstract

AbstractBackgroundNICE has maintained a portfolio of COVID-19 living guidelines since March 2020. Recommendations within these living guidelines are subject to continuous surveillance and updates in response to triggers. However, the lifespan of individual living guideline recommendations and features that may impact on whether a recommendation becomes out of date sooner, is unknown.ObjectivesThis study aimed to describe the length of time NICE COVID-19 living guideline recommendations have remained valid.MethodsAll guidelines within NICE’s COVID-19 portfolio were included to determine the lifespan of living guideline recommendations. Data were collected on all recommendations that had been developed, undergone surveillance or updated between 1 March 2020 and 31 August 2022. Information on initial publication date, decision to update, and update publication date was extracted. Updates were labelled as major changes in evidence synthesis or minor changes without a substantial change in evidence base. Any recommendation that had not been updated or withdrawn was censored. Survival analysis (Kaplan-Meier Curve) was carried out to determine the lifespan of recommendations.ResultsOverall, 26 COVID-19 living guidelines and 1182 recommendations were included in the analysis. Living recommendations had median survival time of 739 days (IQR: 332, 781). Based on recommendation type, intervention recommendations had a shorter survival time (354 days, IQR 312, 775) compared to diagnosis (368 days, IQR: 328, 795), patient experience (733 days, IQR: 345, 795) and service delivery (739 days, IQR: 643, 781). Within intervention type, pharmacological recommendations had shortest survival time versus non-pharmacological recommendations [335 days (IQR: 161, 775) vs 775 days (IQR: 354, 775)]. Updates were published an average of 29.12 days following a surveillance decision.ConclusionWithin living guidelines, some recommendations need to be updated sooner than others. This study outlines the value of a flexible responsive approach to surveillance within the living mode according to pace of change and expectation of update triggers.What is new?Key findingsWithin the context of a living guideline, some recommendations will become out of date sooner than others.What this adds to what was known?This study supports the concept of prioritising recommendations within a guideline to be living.What is the implication and what should change now?Guideline developers should consider which recommendations within a living guideline would have the most value in being maintained as living to optimise resources.