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042 Strong Recommendation – Strong Evidence? An Analysis of Evidence-Based Guidelines on Various Chronic Diseases
  1. U Siering,
  2. S Ein Waldt,
  3. W Hoffmann-Eber,
  4. A Rüther
  1. Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany


Background Several studies have investigated the award of Grades of Recommendation (GoR) and Levels of Evidence (LoE) in clinical practice guidelines of medical societies.

Objectives To assess to what extent recommendations with high GoR are also linked to high LoE in guidelines on various chronic diseases.

Methods We conducted a systematic search for German, English, and French-language evidence-based guidelines on type 1 and 2 diabetes, coronary heart disease, and heart failure published after 1995. Guideline recommendations on the healthcare aspects “diagnosis”, “treatment” and “cooperation of health care sectors”, including their LoE and GoR, were extracted. LoE and GoR were then rated according to aggregated evidence or recommendation categories (weak, medium, strong).

Results 71 guidelines were identified and 3918 recommendations extracted. 3073 (78%) and 2541 (65%) recommendations were supported by GoR and LoE respectively. 1879 recommendations (48%) were supported by both GoR and LoE. In this group, strong GoR were awarded in 839 cases (45%), but only 353 (42%) of them were also linked to strong LoE. Weak and medium LoE were awarded in 264 (32%) and 222 (27%) cases, respectively.

Discussion A large proportion of recommendations in evidence-based guidelines are not supported by both GoR and LoE; the quality of guidelines could be improved here. If both are reported, less than half of recommendations with strong GoR are also linked to strong LoE. This raises the question whether too high GoR are systematically awarded in clinical practice guidelines.

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