Evaluating the Methodological Rigor and Recommendation Excellence of TAVR Guidelines: Insights from AGREE II and AGREE-REX Instruments.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-02-18 DOI:10.1007/s10557-025-07679-0

Jianguo Xu, Qingyong Zheng, Yating Cui, Junfei Wang, Yafei Xie, Lin Li, Ya Gao, Ming Liu, Yu Qin, Jiaxuan Sun, Kang Yi, Jinhui Tian

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引用次数: 0

Abstract

Purpose: Transcatheter aortic valve replacement (TAVR) has emerged as a critical innovation for managing severe aortic stenosis, prompting the development of numerous clinical practice guidelines worldwide. This study systematically evaluates the guideline development methodologies of major international TAVR guidelines using the AGREE II and AGREE-REX instruments, aiming to enhance understanding of current development processes.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and specialized guideline repositories. Twenty-four TAVR-specific guidelines were independently evaluated by four reviewers using the AGREE II and AGREE-REX instruments. The guidelines were categorized as evidence- or consensus-based, and statistical analysis was performed using SPSS to standardize scores and assess inter-rater reliability.

Results: Systematic assessment revealed significant methodological variations across guidelines. The AGREE II evaluation showed the highest performance in scope and purpose (83.9 ± 10.0%) but lower scores in rigor of development (43.5 ± 29.0%) and applicability (42.4 ± 26.8%). The AGREE-REX analysis demonstrated stronger performance in implementability (78.6 ± 14.5%) while identifying gaps in the integration of values and preferences (35.7 ± 17.2%). Evidence-based guidelines consistently outperformed consensus-based ones across multiple domains, particularly in terms of methodological rigor and implementation planning.

Discussion: This evaluation highlights key areas for improving guideline development methodology, including standardized evidence evaluation processes, systematic stakeholder engagement, and structured implementation planning. The considerable variability in methodological quality underscores the need for more standardized approaches.

Conclusion: Current TAVR guidelines exhibit significant heterogeneity in methodological quality, with evidence-based guidelines demonstrating superior performance in development rigor and implementation planning. Systematic approaches to evidence synthesis and stakeholder engagement are crucial for high-quality guideline development.

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评估TAVR指南的方法严谨性和推荐卓越性：来自AGREE II和AGREE- rex工具的见解。

目的：经导管主动脉瓣置换术（TAVR）已成为治疗严重主动脉瓣狭窄的一项关键创新，促进了世界范围内许多临床实践指南的发展。本研究使用AGREE II和AGREE- rex工具系统地评估了主要国际TAVR指南的指南制定方法，旨在加强对当前制定过程的理解。方法：在PubMed， Embase， Web of Science和专门的指南库中进行全面搜索。24项tavr特异性指南由四名审稿人使用AGREE II和AGREE- rex仪器独立评估。指南被分类为基于证据或基于共识，并使用SPSS进行统计分析，以标准化评分并评估评分者之间的信度。结果：系统评估揭示了不同指南在方法上的显著差异。AGREE II评估在范围和目的方面表现最好（83.9±10.0%），但在开发的严谨性（43.5±29.0%）和适用性（42.4±26.8%）方面得分较低。AGREE-REX分析在可实施性方面表现较好（78.6±14.5%），而在价值观和偏好的整合方面发现差距（35.7±17.2%）。基于证据的指导方针在多个领域的表现始终优于基于共识的指导方针，特别是在方法的严谨性和实施计划方面。讨论：该评估强调了改进指南制定方法的关键领域，包括标准化的证据评估过程、系统的利益相关者参与和结构化的实施计划。方法质量的相当大的可变性强调了需要更标准化的方法。结论：目前的TAVR指南在方法学质量上表现出显著的异质性，循证指南在制定严谨性和实施计划方面表现出卓越的表现。证据综合的系统方法和利益相关者的参与对于高质量指南的制定至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.