{"id":43969,"date":"2014-07-14T08:00:15","date_gmt":"2014-07-14T12:00:15","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=43969"},"modified":"2014-07-14T16:22:57","modified_gmt":"2014-07-14T20:22:57","slug":"poor-retention-of-guideline-recommendations","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/07\/14\/poor-retention-of-guideline-recommendations\/","title":{"rendered":"Poor Retention of Guideline Recommendations"},"content":{"rendered":"<p><em>In <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1874510\">an article published in the May 28th edition of <\/a><\/em><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1874510\">JAMA<\/a><em>, a group of physicians addressed the question of the\u00a0retention of clinical practice guideline recommendations over time.\u00a0The investigators assessed the durability of Class I recommendations to provide a perspective on how often actions that are deemed mandatory become less enthusiastically endorsed as more evidence emerges.<\/em><\/p>\n<p>Of 619 Class I recommendations in 11 index guidelines published between 1998 and 2007, 20% of the recommendations did not appear in the subsequent guideline and 9.2% were downgraded or reversed. Even among the recommendations that were supported by multiple trials, 5.7% were not retained in subsequent versions of guidelines and 3.8% were downgraded or reversed. The Class I recommendations at the highest risk for being omitted, downgraded, or reversed were those based on consensus opinion, followed by those based on a single randomized trial or nonrandomized trials.<\/p>\n<p>I would have thought that the strongest recommendations in a guideline would be very unlikely to change over time. In this disturbing study, a substantial proportion of Class I recommendations were not durable over even a 10-year period, showing us that uncertainty surrounds even the strongest guideline recommendations. I wonder whether the writing committees would have been able to predict which of the Class I recommendations were most likely to be omitted, downgraded, or reversed based on future studies. I&#8217;d bet they could not have guessed correctly.<\/p>\n<p><strong>JOIN THE DISCUSSION<\/strong><\/p>\n<p><em><strong>Why do you think such a high percentage of guideline recommendations are omitted, downgraded or reversed? Does this information affect your opinion of the importance of existing guidel<\/strong>i<strong>nes?<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Harlan Krumholz discusses a JAMA study that found a substantial proportion of Class I guideline recommendations were not durable over a 10-year period.<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[733,202],"class_list":["post-43969","post","type-post","status-publish","format-standard","hentry","category-general","tag-jama","tag-practice-guidelines"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/43969","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=43969"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/43969\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=43969"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=43969"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=43969"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}