Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yiwen ^1,2 , LIU Yanfei ³ , CUI Jing ¹ , HUANG Luqi ² , CHEN Keyi ¹ ,  LIU Yue ^1,2

1. National Clinical Research Center of Cardiovascular Diseases of Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;
2. China Center for Evidence-Based Medicine of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P.R.China;
3. Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, P.R.China;

Corresponding author：

LIU Yue, Email: liuyue@188.com

Keywords：

Coronary heart disease; Traditional Chinese medicine; Clinical practice guideline; Quality assessment; AGREE Ⅱ

DOI：

10.7507/1672-2531.202102029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the methodological quality of traditional Chinese medicine (TCM) guidelines and expert consensuses for the diagnosis and treatment of coronary heart diseases (CHD).Methods Databases including PubMed, CNKI, CBM, WanFang Data and the official websites of the China Association of Traditional Chinese Medicine, and the Chinese Association of Integrated Traditional and Western Medicine were electronically searched to collect guidelines (or expert consensus) of TCM for CHD from January 1^st, 2010 to January 1^st, 2021. Methodological evaluation of the included guidelines was conducted by 3 researchers independently using the AGREE Ⅱ instrument.Results A total of 16 guidelines were included. The AGREE Ⅱ scores for each domain were: clarity and presentation (63.89%), followed by scope and purpose (55.90%), stakeholder involvement (42.13%), the rigor of development (41.42%), editorial independence (32.12%), and applicability (21.99%). Nine guidelines were rated as level B (recommended after being revised), and 7 were rated as level C (not recommended).Conclusions Guidelines and expert consensuses of TCM for CHD provide a standard for clinical practice, however, the methodological quality remains to be improved. It is suggested that future guidelines be formulated in accordance with international standards and using the methods of evidence-based medicine to improve the quality of guidelines further and promote international acceptability.

Citation： LI Yiwen, LIU Yanfei, CUI Jing, HUANG Luqi, CHEN Keyi, LIU Yue. Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases. Chinese Journal of Evidence-Based Medicine, 2021, 21(6): 696-702. doi: 10.7507/1672-2531.202102029 Copy

1.	《中国心血管健康与疾病报告》编写组. 《中国心血管健康与疾病报告2019》要点解读. 中国心血管杂志, 2020, 25(5): 401-410.
2.	Moran A, Gu D, Zhao D, et al. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes, 2010, 3(3): 243-252.
3.	Duan X, Zhou L, Wu T, et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database Syst Rev, 2008, (1): CD004473.
4.	Mao C, Fu XH, Yuan JQ, et al. Tong-xin-luo capsule for patients with coronary heart disease after percutaneous coronary intervention. Cochrane Database Syst Rev, 2015, (5): CD010237.
5.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
6.	Institute of Medicine. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.
7.	Institute of Medicine. Setting priorities for clinical practice guidelines. Washington, DC: National Academy Press, 1995.
8.	Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: The National Academies Press, 2011.
9.	陈耀龙, 罗旭飞, 王吉耀, 等. 如何区分临床实践指南与专家共识. 协和医学杂志, 2019, 10(4): 403-408.
10.	Appraisal of guidelines for research & evaluation Ⅱ instrument. Available from:http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf.
11.	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读. 中国循证儿科杂志, 2013, 8(4): 316-319.
12.	中国中医科学院. 中医循证临床实践指南·中医内科. 北京: 中国中医药出版社, 2011.
13.	中华中医药学会心血管病分会. 冠心病稳定型心绞痛中医诊疗指南. 中医杂志, 2019, 60(21): 1880-1890.
14.	中华中医药学会心血管病分会. 冠心病稳定型心绞痛中医诊疗专家共识. 中医杂志, 2018, 59(5): 447-450.
15.	蔡光先, 颜旭, 宁泽璞, 等. 内科常见疾病中医证治国际标准(草案)冠心病心绞痛. 湖南中医杂志, 2010, 26(4): 97-99.
16.	中华中医药学会. 胸痹心痛中医诊疗指南. 中国中医药现代远程教育, 2011, 9(23): 106-107.
17.	中华中医药学会. 中医内科常见病诊疗指南(西医疾病部分)冠心病心绞痛. 中国中医药现代远程教育, 2011, 9(18): 143-145.
18.	中国中医药研究促进会中西医结合心血管病预防与康复专业委员会. 稳定性冠心病中西医结合康复治疗专家共识. 中西医结合心脑血管病杂志, 2019, 17(3): 321-329.
19.	中国医师协会中西医结合医师分会, 中国中西医结合学会心血管病专业委员会, 中国中西医结合学会重症医学专业委员会, 等. 急性心肌梗死中西医结合诊疗指南. 中国中西医结合杂志, 2018, 38(3): 272-284.
20.	中国医师协会中西医结合医师分会, 中国中西医结合学会心血管病专业委员会, 中国中西医结合学会重症医学专业委员会, 等. 急性心肌梗死中西医结合诊疗专家共识. 中国中西医结合杂志, 2014, 34(4): 389-395.
21.	陈可冀, 史大卓. 冠心病及急性心肌梗死中医临床辨证标准及防治指南. 北京: 人民卫生出版社, 2014.
22.	Liao PD, Chen KJ, Ge JB, et al. Clinical practice guideline of integrative Chinese and Western medicine for acute myocardial infarction. Chin J Integr Med, 2020, 26(7): 539-551.
23.	中华中医药学会心血管病分会. 冠心病心绞痛介入前后中医诊疗指南. 中国实验方剂学杂志, 2018, 24(15): 4-6.
24.	世界中医药联合会心血管病专业委员会, 中国中西医结合学会心血管病专业委员会, 中华中医药学会介入心脏病学会, 等. 冠状动脉血运重建术后心绞痛中西医结合诊疗指南. 中国中西医结合杂志, 2020, 40(11): 1298-1307.
25.	中华中医药学会介入心脏病学专家委员会. 经皮冠状动脉介入治疗(PCI)术后胸痛中医诊疗专家共识. 中医杂志, 2014, 55(13): 1167-1170.
26.	世界中医药学会联合会介入心脏病专业委员会, 中华中医药学会介入心脏病专业委员会, 中国中西医结合学会心血管病专业委员会介入心脏病学组, 等. 经皮冠状动脉介入治疗围手术期心肌损伤中医诊疗专家共识. 中国中西医结合杂志, 2017, 37(4): 389-393.
27.	国家心血管病中心中西医结合Ⅰ期心脏康复专家共识委员会. 中西医结合冠状动脉旁路移植术Ⅰ期心脏康复专家共识. 中国循环杂志, 2017, 32(4): 314-317.
28.	Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy, 2009, 64(5): 669-677.
29.	Dalen JE, Alpert JS, Goldberg RJ, et al. The epidemic of the 20(th) century: coronary heart disease. Am J Med, 2014, 127(9): 807-812.
30.	Angelis A, Kanavos P. Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework. Soc Sci Med, 2017, 188: 137-156.
31.	Zhao L, Li D, Zheng H, et al. Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med, 2019, 179(10): 1388-1397.
32.	Mao S, Zhang X, Shao B, et al. Baduanjin exercise prevents post-myocardial infarction left ventricular remodeling (BE-PREMIER trial): design and rationale of a pragmatic randomized controlled trial. Cardiovasc Drugs Ther, 2016, 30(3): 315-322.
33.	Salmoirago-Blotcher E, Wayne PM, Dunsiger S, et al. Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc, 2017, 6(10): e006603.
34.	杨衍涛, 郑明福, 王健健, 等. 中医药临床实践指南和专家共识引用系统评价/Meta分析现况调查. 中国循证医学杂志, 2021, 21(1): 83-89.
35.	Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.
36.	张晓雨, 陈诗琪, 李承羽, 等. 循证中医药学理论研究与应用实践. 中国循证医学杂志, 2018, 18(1): 86-91.
37.	杨颖, 毕颖斐, 王贤良, 等. 基于AGREEⅡ的中医药治疗心血管病指南/共识质量评价. 中西医结合心脑血管病杂志, 2020, 18(7): 1030-1038.
38.	刘道践, 陈俊国, 李源, 等. 一个中国化医学临床指南评价工具的研发. 中国医学装备, 2012, (9): 11-14.
39.	崔树起, 梁万年. 临床指南实践手册. 北京: 人民卫生出版社, 2003.

1. 《中国心血管健康与疾病报告》编写组. 《中国心血管健康与疾病报告2019》要点解读. 中国心血管杂志, 2020, 25(5): 401-410.
2. Moran A, Gu D, Zhao D, et al. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes, 2010, 3(3): 243-252.
3. Duan X, Zhou L, Wu T, et al. Chinese herbal medicine suxiao jiuxin wan for angina pectoris. Cochrane Database Syst Rev, 2008, (1): CD004473.
4. Mao C, Fu XH, Yuan JQ, et al. Tong-xin-luo capsule for patients with coronary heart disease after percutaneous coronary intervention. Cochrane Database Syst Rev, 2015, (5): CD010237.
5. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-842.
6. Institute of Medicine. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.
7. Institute of Medicine. Setting priorities for clinical practice guidelines. Washington, DC: National Academy Press, 1995.
8. Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: The National Academies Press, 2011.
9. 陈耀龙, 罗旭飞, 王吉耀, 等. 如何区分临床实践指南与专家共识. 协和医学杂志, 2019, 10(4): 403-408.
10. Appraisal of guidelines for research & evaluation Ⅱ instrument. Available from:http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf.
11. 韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读. 中国循证儿科杂志, 2013, 8(4): 316-319.
12. 中国中医科学院. 中医循证临床实践指南·中医内科. 北京: 中国中医药出版社, 2011.
13. 中华中医药学会心血管病分会. 冠心病稳定型心绞痛中医诊疗指南. 中医杂志, 2019, 60(21): 1880-1890.
14. 中华中医药学会心血管病分会. 冠心病稳定型心绞痛中医诊疗专家共识. 中医杂志, 2018, 59(5): 447-450.
15. 蔡光先, 颜旭, 宁泽璞, 等. 内科常见疾病中医证治国际标准(草案)冠心病心绞痛. 湖南中医杂志, 2010, 26(4): 97-99.
16. 中华中医药学会. 胸痹心痛中医诊疗指南. 中国中医药现代远程教育, 2011, 9(23): 106-107.
17. 中华中医药学会. 中医内科常见病诊疗指南(西医疾病部分)冠心病心绞痛. 中国中医药现代远程教育, 2011, 9(18): 143-145.
18. 中国中医药研究促进会中西医结合心血管病预防与康复专业委员会. 稳定性冠心病中西医结合康复治疗专家共识. 中西医结合心脑血管病杂志, 2019, 17(3): 321-329.
19. 中国医师协会中西医结合医师分会, 中国中西医结合学会心血管病专业委员会, 中国中西医结合学会重症医学专业委员会, 等. 急性心肌梗死中西医结合诊疗指南. 中国中西医结合杂志, 2018, 38(3): 272-284.
20. 中国医师协会中西医结合医师分会, 中国中西医结合学会心血管病专业委员会, 中国中西医结合学会重症医学专业委员会, 等. 急性心肌梗死中西医结合诊疗专家共识. 中国中西医结合杂志, 2014, 34(4): 389-395.
21. 陈可冀, 史大卓. 冠心病及急性心肌梗死中医临床辨证标准及防治指南. 北京: 人民卫生出版社, 2014.
22. Liao PD, Chen KJ, Ge JB, et al. Clinical practice guideline of integrative Chinese and Western medicine for acute myocardial infarction. Chin J Integr Med, 2020, 26(7): 539-551.
23. 中华中医药学会心血管病分会. 冠心病心绞痛介入前后中医诊疗指南. 中国实验方剂学杂志, 2018, 24(15): 4-6.
24. 世界中医药联合会心血管病专业委员会, 中国中西医结合学会心血管病专业委员会, 中华中医药学会介入心脏病学会, 等. 冠状动脉血运重建术后心绞痛中西医结合诊疗指南. 中国中西医结合杂志, 2020, 40(11): 1298-1307.
25. 中华中医药学会介入心脏病学专家委员会. 经皮冠状动脉介入治疗(PCI)术后胸痛中医诊疗专家共识. 中医杂志, 2014, 55(13): 1167-1170.
26. 世界中医药学会联合会介入心脏病专业委员会, 中华中医药学会介入心脏病专业委员会, 中国中西医结合学会心血管病专业委员会介入心脏病学组, 等. 经皮冠状动脉介入治疗围手术期心肌损伤中医诊疗专家共识. 中国中西医结合杂志, 2017, 37(4): 389-393.
27. 国家心血管病中心中西医结合Ⅰ期心脏康复专家共识委员会. 中西医结合冠状动脉旁路移植术Ⅰ期心脏康复专家共识. 中国循环杂志, 2017, 32(4): 314-317.
28. Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy, 2009, 64(5): 669-677.
29. Dalen JE, Alpert JS, Goldberg RJ, et al. The epidemic of the 20(th) century: coronary heart disease. Am J Med, 2014, 127(9): 807-812.
30. Angelis A, Kanavos P. Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework. Soc Sci Med, 2017, 188: 137-156.
31. Zhao L, Li D, Zheng H, et al. Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med, 2019, 179(10): 1388-1397.
32. Mao S, Zhang X, Shao B, et al. Baduanjin exercise prevents post-myocardial infarction left ventricular remodeling (BE-PREMIER trial): design and rationale of a pragmatic randomized controlled trial. Cardiovasc Drugs Ther, 2016, 30(3): 315-322.
33. Salmoirago-Blotcher E, Wayne PM, Dunsiger S, et al. Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation. J Am Heart Assoc, 2017, 6(10): e006603.
34. 杨衍涛, 郑明福, 王健健, 等. 中医药临床实践指南和专家共识引用系统评价/Meta分析现况调查. 中国循证医学杂志, 2021, 21(1): 83-89.
35. Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.
36. 张晓雨, 陈诗琪, 李承羽, 等. 循证中医药学理论研究与应用实践. 中国循证医学杂志, 2018, 18(1): 86-91.
37. 杨颖, 毕颖斐, 王贤良, 等. 基于AGREEⅡ的中医药治疗心血管病指南/共识质量评价. 中西医结合心脑血管病杂志, 2020, 18(7): 1030-1038.
38. 刘道践, 陈俊国, 李源, 等. 一个中国化医学临床指南评价工具的研发. 中国医学装备, 2012, (9): 11-14.
39. 崔树起, 梁万年. 临床指南实践手册. 北京: 人民卫生出版社, 2003.

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Quality assessment of clinical practice guidelines of traditional Chinese medicine for coronary heart diseases

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