Criticism to the revascularization indications attained in the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease
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Abstract
Clinical practice guidelines are valuable tools that guide doctors' conduct in a series of diseases with high prevalence in the population. The 2023 guideline on chronic coronary disease (CCD), written by the American Heart Association and the American College of Cardiology in conjunction with other American entities is no exception to this rule and although it is designed for application in American medical practice, it gains relevance for use in care of patients affected by this disease worldwide 1.
The guidelines help healthcare professionals the best decision-making, with the aim of offering the best possible care to patients, aligned with their expectations, needs and interests. Furthermore, they are important documents for governments, payers and healthcare providers by providing a set of recommendations that help and guide decisions about coverage of diagnostic and therapeutic procedures related to diseases with high prevalence in the population.
In this 2023 guideline, the authors say that revascularization is an evolving topic and emphasize that recommendations are typically based on the results of larger randomized controlled trials (RCTs), meta-analyses, or both encompassing a wide range of knowledge on the subject. but they recognize that RCTs do not cover all the nuances involved with the topic, nor do they address all issues comprehensively. Based on this, they made a concentrated effort to stay within the strongest evidence to define these revascularization recommendations in patients with CCD.
Within this principle, reviewing chapter 5 dedicated specifically to myocardial revascularization, we are concerned, among other things, with the recommendations resulting from the analysis of some studies that do not clearly reflect the reality of contemporary care provided to patients with CCD, in addition to events that do not reflect the primary outcomes of many of these studies. For this reason, we performed a careful review of the most relevant randomized controlled trials (RCTs), systematic reviews and meta-analyses used in the guideline for revascularization recommendations, which impact a significant number of patients affected by CCD worldwide.
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