Comparing methodological quality and consistency of international guidelines for the management of patients with chronic heart failure.
BACKGROUND
Guidelines (GLs) for the management of heart failure (HF) are of great importance in order to define and disseminate therapeutic recommendations based on scientific evidence. The aim was to analyse and to compare the methodological quality of HF GLs as well as to evaluate the consistency of therapeutic recommendations.


METHODS
Eleven international GLs for the management of chronic HF were identified by search of the internet, electronic databases and references of published literature. Their methodological quality was assessed by two different appraisal instruments: (1) according to the US National Guideline Clearinghouse (NGC) on a scale from 0 to 17 points, (2) according to the German Guideline Clearinghouse (Agency for Quality in Medicine, AQUMED) on a scale from 0 to 44 points. Clinical criteria for assessment of the consistency of the recommendations included diagnostic testing, pharmacological and non-pharmacological treatment.


RESULTS
The quality scores of the GLs varied substantially with a range of 1.5-15.5 points (NGC) and 8-30 points (AQUMED). The greatest variation was found in the dimensions "development" and "evidence". Only 3 of the 11 GLs (approximately 30%) were rated as methodologically well prepared. The recommendations on diagnostic procedures and medical management were rather consistent among the different GLs.


CONCLUSIONS
Published international GL recommendations on medical management of patients with chronic HF are broadly consistent. The methodological quality of the GLs, however, varies to a great extent. Improvement is needed in most methodological aspects, especially in the dimensions "evidence" and "applicability".
Kulig
Michael
M
Institute of Social Medicine, Epidemiology and Health Economics, Charité Hospital, Humboldt University of Berlin, D-10098 Berlin, Germany. michael.kulig@charite.de
Schulte
Erika
E
Erika
Schulte
S
Willich
Stefan
S
Norbert
Willich Stefan
WS
D002908:Chronic Disease; D019468:Disease Management; D005060:Europe; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D009520:New Zealand; D009656:North America; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*