• Aya J Alame, Aris Karatasakis, Judit Karacsonyi, Barbara A Danek, Paul Sorajja, Mario Gössl, Santiago Garcia, Hani Jneid, Nikolaos Kakouros, Jose Roberto Martinez-Parachini, Erica Resendes, Pratik Kalsaria, Michele Roesle, Bavana V Rangan, Subhash Banerjee, and Emmanouil S Brilakis.
• Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.
• J Invasive Cardiol. 2017 Sep 1; 29 (9): 320-326.

BackgroundThe American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have developed guidelines to assist clinicians in making evidence-based decisions. This study compares the ACC/AHA and ESC guidelines for the management of patients with valvular heart disease (VHD).MethodsThe current ACC/AHA and ESC guidelines for VHD, last updated in 2014 and 2012, respectively, were compared by class of recommendation (COR), level of evidence (LOE), and content.ResultsThe ACC/AHA and ESC VHD guidelines contain 229 and 85 recommendations, respectively. The COR distributions of the ACC/AHA and ESC VHD guidelines were 47.6% vs 44.7% class I [P=.65]; 46.3% vs 55.3% class II [P=.16]; and 6.1% vs 0.0% class III [P=.01], respectively. The LOE distributions were 3.1% vs 0.0% LOE A [P=.20]; 47.2% vs 10.6% LOE B [P<.001]; and 49.8% vs 89.4% LOE C [P<.001], respectively. The recommendation type distributions were 31.0% vs 2.4% diagnostic [P<.001]; 23.1% vs 16.5% medical therapy [P=.20]; and 45.9% vs 81.2% interventional/surgical recommendations [P<.001], respectively. The content of the guidelines was similar, with only minor differences in a few recommendations.ConclusionsThe ACC/AHA VHD guidelines contain significantly more recommendations. The distribution of COR was similar, but the ACC/AHA guidelines included more LOE B recommendations and fewer LOE C recommendations, suggesting that the ACC/AHA guidelines place greater emphasis on published data than expert opinion. Overall, the ACC/AHA and ESC guidelines provide similar recommendations, suggesting consistency in practice; however, the relative paucity of LOE A recommendations highlights the need for additional research.

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