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Weak Evidence Backs Most Heart Guidelines, Report Finds
Date:2/24/2009

Experts agree that field needs more rigorous trials to aid doctors,,

TUESDAY, Feb. 24 (HealthDay News) -- A majority of the guidelines for cardiac care issued by the American Heart Association and the American College of Cardiology are not supported by the kind of gold-standard evidence that doctors respect most, a new study finds.

That conclusion does not come from heretics crying in the wilderness. One author of the report, published in the Journal of the American Medical Association, is Dr. Sidney Smith, a professor of medicine at the University of North Carolina, a past president of the heart association and former chairman of the AHA/ACC Guidelines Task Force.

The findings were quickly endorsed by Dr. Timothy J. Gardner, current AHA president.

"There are many situations we encounter where we don't have as strong evidence for the guidelines as we would like to have," said Gardner, who is medical director of the Center for Heart & Vascular Health at the Christiana Care Health System in Delaware. "There haven't been enough randomized trials."

And too many of the carefully controlled trials now being done are financed by pharmaceutical companies, said Dr. Pierluigi Tricoci, a cardiologist at the Duke Heart Center and another member of the team that did the study.

"Most major clinical trials are sponsored by the pharmaceutical industry, because they want to bring products to market," Tricoci said. "We don't have a source of funding for those situations that the pharmaceutical industry might not be interested in. We should not be surprised that the pharmaceutical industry is not interested in trials from which they might not make money."

Tricoci was an originator of the project that looked at the evidence supporting cardiac care guidelines, which have multiplied in number in recent years. The project investigators examined 53 guidelines on 22 topics, with a total of 7,196 rec
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