Clinical practice guidelines
Looking for evidence
Keywords:
CLINICAL PRACTICE GUIDE, EVIDENCE BASED PRACTICEAbstract
Introduction: clinical practice guidelines based on evidence constitute a tool to provide quality health care services from the individual and social perspective, and at the same time, they provide physicians with backup. Accepting guidelines without questioning them is a deeply rooted phenomenon in our country – when they come from prestigious international organizations.
Objective: to demonstrate that in cardiology we need to have nationally prepared guidelines that enable the best handling of our patients.
Method: 1) critical analysis of the evidence on which the recommendations in an American practical guideline are based, and the impact of its application in our country; 2) analysis of the validity of clinical trials that provide the grounds for a recent European guideline.
Results: using the American guideline in our country proved that despite 89% of the indications corresponded to cases where there is general agreement and/or evidence/opinion in favor of its relevance, 23.6% of patients had normal coronary arteries. Randomized clinical trials supporting the European recommendations are not valid, in spite of their being regarded as recommendations based on best quality evidence.
Conclusions: even if practice guidelines developed by organizations in other countries may be valuable, it is not convenient to transfer them directly to our country without a critical analysis of the studies supporting their recommendations and without complementing this information with national evidence and the opinion of local experts in those areas where there is no evidence arising from the relevant studies.
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