Healthy Skepticism Library item: 17127

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Publication type: Journal Article

Gibbons RJ, Gray AM, Gray GD, Antman EM, Smith SC
Has guideline development gone astray? No
BMJ 2010 Jan 29; 340:
http://www.bmj.com/cgi/content/full/340/jan29_1/c343

Abstract:

Guideline development in cardiovascular diseases is a well developed process in both the United States and Europe that has enhanced the delivery of proved treatments and improved patient outcomes. It most certainly has not gone astray.

Between 1970 and 2000, life expectancy in the United States increased by six years,1 with nearly two thirds of that increase, 3.9 years, due to improved outcomes in cardiovascular diseases and stroke. Half of the improvement in coronary heart disease mortality was due to improvement in population risk factors; the other half could be attributed to improved evidence based treatment.2

Unfortunately, proved treatment strategies were not consistently applied. Permanent pacemakers were definitely justified in less than half of patients who received one and not justified about 20% of the time.3 Less than half of patients presenting with acute myocardial infarction who had had a previous event and no contraindications were taking aspirin.4 Angiotensin converting . . .