Critical appraisal of dyslipidaemia clinical practice guidelines: a scoping review
- At: PPR 2022 (2022)
- Type: Poster
- By: STUMPF TONIN, Fernanda (H&trc Estesl-ipl (portugal) And Federal University Of Paraná (brasil))
- Co-author(s): Flávia Deffert, H&TRC ESTeSL-IPL (Portugal) and Federal University of Paraná (Brazil), Portugal
Fernanda Tonin, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Brazil
Roberto Pontarolo, Department of Pharmacy, Federal University of Paraná, Brazil
Fernando Fernandez-Llimos, CINTESIS - Center for Health Technology and Services Research, Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Portugal
Background information: Dyslipidaemia, the unbalanced level of lipoproteins and triglycerides, contributes to or aggravates cardiovascular diseases. In 2019, high LDL-c levels were responsible for 5 million deaths worldwide. Several clinical practice guidelines (CPG) about dyslipidaemia aiming at guiding healthcare professionals towards more assertive decisions exist. However, previous studies reported low quality of the clinical content and evidence supporting recommendations provided by CPGs in different areas, and a lack of involvement of multi-professional experts and stakeholders, such as pharmacists, into their development. This may lead to inconsistencies and risk of bias in decision-making and negatively impact on patients’ outcomes. The quality of CPG can be assessed through Appraisal of Guidelines, Research and Evaluation (AGREE) tools as the AGREE II (methodological assessment) and AGREE REX (clinical recommendations).
Purpose: We aim to evaluate the quality of available CPG on dyslipidaemia and assess the extent of involvement of stakeholders using AGREE II and AGREE REX appraisal tools.
Method: A scoping review following Cochrane Collaboration and PRISMA recommendations was performed. Systematic searches to retrieve CPG on the use of pharmacological treatments in adult patients with dyslipidaemia (written in Portuguese, Spanish, English, French, German) were conducted in PubMed and Scopus. The eligible records had their data extracted and were assessed using AGREE II (23 quality items within 6 domains: scope and purpose; stakeholder involvement; rigor of development; clarity of presentation; applicability; editorial independence) and AGREE REX (9 items within 3 domains: clinical applicability; values and preferences; local application and adoption). Both instruments were applied following the original users’ manual guide. Grades of dominions were reported as percentages, items as absolute rates (1.0 to 7.0 scale) and final scores as median [minimum-maximum].
Results: Twenty guidelines (Brazil, Canada, Europe, India, Mexico, Poland, South Africa, United States), mainly authored by professional societies (95%) and targeting clinicians as their primarily users were selected. The overall quality of CPG was low-moderate (mean 65% in AGREE II and 46% in AGREE REX). All guidelines lack on discussing the role of patients or caretakers on treatment decisions and most of them were methodologically poorly developed (low score on the ‘Rigor of Development’ domain, <45%). The Domain 1 from AGREE II (‘Scope and Purpose’) presented the higher rates of compliance (95%). Conversely, only half of CPG (56%; [36-74]) comply with the AGREE II Domain 2 (‘Stakeholder Involvement’); its three items (participation of all relevant professional groups, patients and caretakers’ involvement, definition of the target users) were rated as 4 (1.8-6.3), 2 (1.0-4.0) and 7 (6.0-7.0), respectively. The Domains 1 and 2 of the AGREE REX (‘Clinical Applicability’ and ‘Values and Preferences’) were graded as 66% [20-94] and 34% [19-44], respectively. No statistical difference between results of the same dominion were found.
Conclusion: Dyslipidaemia’s CPG can be improved especially regarding evidence updating, compliance with quality standards for literature search, appraisal and recommendations, and the addition of stakeholders’ values and preferences.