Critique of Clinical Practice Guidelines

Guidelines have strayed from their original purpose and value — perhaps it’s time for new approaches.

Clinical practice guidelines (CPGs), once somewhat spare and elegant in their creation, dissemination, and application, have become commonplace, tedious, and of questionable clinical relevance.

In a review of all American College of Cardiology and American Heart Association (ACC/AHA) CPGs that were issued from 1984 to 2008 (53 CPGs with 7196 recommendations on 22 topics), 16 current guidelines provided evidence levels for supporting data.1 Only 314 of 2711 recommendations that provided evidence levels were supported by level A evidence (multiple randomized trials or meta-analyses). Nearly half these recommendations (1246) were supported by only level C evidence (expert opinion, case studies, or standards of care). Only 245 of 1305 level I re…

Author

Thomas L. Schwenk, MD

Disclosures

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Thomas L. Schwenk, MD

Disclosures

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