慢性心力衰竭防治指南和共识的方法学质量评价

Quality assessment of clinical practice guidelines and expert consensus for chronic heart failure

目的对国内外慢性心力衰竭临床实践指南和专家共识进行方法学质量评价。方法计算机检索PubMed、EMbase、SinoMed、CNKI、WanFang Data、VIP数据库和相关网站,搜集慢性心力衰竭中医及西医诊疗指南(或专家共识),检索时限均为2011年1月1日至2020年12月31日。由4名评价员经一致性评价后,使用AGREEⅡ工具对纳入的指南或专家共识进行方法学质量评价。结果共纳入17部指南(英文11部,中文6部)。推荐级别为:B级(修改完善后推荐)10部、C级(不推荐)7部;AGREEⅡ6个领域的平均得分依次为:范围和目的(69.61%)、参与人员(34.20%)、制订的严谨性(33.13%)、表达的明晰性(84.53%)、应用性(42.40%)、编辑独立性(37.09%)。英文指南的方法学质量整体较好(B级10部,C级1部),而中文指南或共识在6个领域的得分几乎全部低于平均分(C级6部)。结论慢性心力衰竭诊疗指南在参与人员和制订的严谨性方面需进一步完善,中文指南或专家共识应在多个方面提升指南质量,以更好地服务于临床实践。

Objective To evaluate the methodological quality of clinical practice guidelines and expert consensus of chronic heart failure domestically and abroad.Methods PubMed,EMbase,SinoMed,CNKI,WanFang Data,and VIP databases,and related websites were searched to collect guidelines and expert consensus on chronic heart failure published from January 1st,2011 to December 31 st,2020.Four reviewers evaluated the methodological quality of the guidelines and expert consensus with the AGREEⅡtool after the consistency evaluation training.Results A total of 17 studies were included(consisting of 11 English and 6 Chinese studies).The recommended levels were B level(recommend after modification)for 10 studies and C level(not recommended)for 7 studies.The AGREEⅡstandardized mean scores for various fields were 69.61%(scope and purpose),34.20%(stakeholder involvement),33.13%(rigor of development),84.53%(clarity and presentation),42.40%(applicability),and 37.09%(editorial independence).The methodological quality of English guidelines was generally high(level B for 10 and level C for 1),while all scores of Chinese guidelines or consensus in the 6 fields were mostly lower than the average(level C for 6).Conclusions The guidelines for the diagnosis and treatment of chronic heart failure requires further improvement in terms of stakeholder involvement and rigor of development.It should develop standards and methods to improve the quality for Chinese guidelines and expert consensus to better serve clinical practice.