[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Citations 0
July 8, 2009

Clinical Practice Guidelines and Scientific Evidence

JAMA. 2009;302(2):142-147. doi:10.1001/jama.2009.909

To the Editor: In their study, Dr Tricoci and colleagues1 pointed out that less than one-fifth of recommendations advocating a particular procedure or treatment in ACC/AHA practice guidelines were based on level A evidence. However, in using the ACC/AHA evidence grading schema to judge the quality of evidence underpinning guideline recommendations, I believe they have overestimated the strength of this evidence base. For example, under the ACC/AHA schema RCTs or meta-analyses are deemed to be level A evidence (or at worst level B if there is only a single RCT or the RCTs are small) irrespective of study conduct, end points evaluated (surrogate outcomes vs patient-centered outcomes), or the applicability of that RCT to the clinical scenario for which the recommendation is being made.

First Page Preview View Large
First page PDF preview
First page PDF preview