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Table 4 Results of Consistency Analysis and Validation

From: The Systematic Guideline Review: Method, rationale, and test on chronic heart failure

Type Clinical Question Consistency Analysis Validation Comment
(1) Use of ACE inhibitors in systolic CHF, all NYHA classes (incl. asymptomatic patients NYHA class I, with or without history of myocardial infarction) 16/16 'recommended' Partly justified Benefit was shown for symptomatic patients (all outcomes incl. mortality), in asymptomatic patients NYHA class I: improvement of prognosis and morbidity, but no evidence for a mortality reduction (see text)
  Use of beta-blockers in systolic CHF, NYHA I post myocardial infarction 11/11 'recommended' Completely justified Cited sources provided the reported evidence in form and content
  Use of beta-blockers in systolic CHF, NYHA II-III 16/16 'recommended' Completely justified Cited sources provided the reported evidence in form and content
(2) Use of aldosterone antagonists in systolic CHF, NYHA III/IV 16/16 'recommended' Justified Cited sources provided evidence on effectiveness; further research is needed on safety (see text)
  Use of digoxin in systolic CHF with tachyarrhythmia 15/15 'recommended' Partly justified Evidence level were revised (see text)
  Control of hypertension in diastolic CHF 2/2 'recommended' Not justified Insufficient evidence, further research is needed (see text)
  Use of anticoagulants in patients with the combination of CHF and atrial fibrillation and/or a history of thromboembolism 12/12 'recommended' - No re-assessment: recommendations referred to atrial fibrillation (out of scope in the target guideline)
(4) Exercise Training 13/13 'recommended' - No re-assessment: evidence was to be found in a newly identified meta-analysis [63]
  Diuretics in systolic CHF, NYHA II-IV 14/14 'recommended' Partly justified Evidence level was revised (see text)
  Use of hydralazine plus ISDN in ACE inhibitor-/ARB-intolerant patients 10/10 'recommended' - No re-assessment: no market availability for the fixed combination in the target context
  Harmlessness of long-acting dihydropyridines 7/7 'recommended' Partly justified Evidence levels not justified; evidence insufficient, further research is needed
(B) Salt and fluid restriction (varying quantification) 9/10 'recommended', 1/10 'not recommended' - No validation: recommendations based on expert consensus
  Beta-blockers in clinical stable systolic CHF, NYHA IV 13/15 'recommended', 2/15 'not recommended' Majority was justified, minority was rejected Positive recommendations completely justified, negative recommendations based on insufficient evidence
  Beta-blockers in all systolic CHF, NYHA I – no matter whether post myocardial infarction or non-ischemic genesis 7/8 'recommended', 1/8 'consideration recommended' Majority was not justified, minority was accepted No evidence for strong recommendation (see text)
  ARB in ACE intolerant patients 15/16 'recommended', 1/16 potentially harmful therapy Majority justified, minority rejected Positive recommendations justified, negative recommendations based on insufficient evidence
  1. Numerical proportion of the mandating to guidelines which covered the scope and reported evidence levels and graded their recommendation. Type-3-consistencies – based on weak evidence – and type-A-inconsistencies are not listed in this table, as they were not included in the validation procedure but needed further research for evidence (a list is provided as additional web-based material, TABLE W5).