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Zhou X, Ye Y, Jin A, Pan Z, Xu Z, Ding S, Yan J, Cheng Y, Huang Y, Cao K, Xie W, Zhang J, Xu L, Zhou W, Huang L. Development and implementation of evidence-based, nurse-leading early warning model and healthcare quality improvement project for transplant-associated thrombotic microangiopathy: a mixed-methods, before-and-after study. BMC Nurs 2024; 23:535. [PMID: 39113009 PMCID: PMC11304727 DOI: 10.1186/s12912-024-02093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/13/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVE The early identification and diagnosis of transplant-associated thrombotic microangiopathy (TA-TMA) are essential yet difficult in patients underwent hematopoietic stem cell transplantation (HSCT). To develop an evidence-based, nurse-leading early warning model for TA-TMA, and implement the healthcare quality review and improvement project. METHODS This study was a mixed-methods, before-and-after study. The early warning model was developed based on quality evidence from literature search. The healthcare quality review and improvement project mainly included baseline investigation of nurse, improvement action and effectiveness evaluation. The awareness and knowledge of early parameter of TA-TMA among nurses and the prognosis of patients underwent HSCT were compared before and after the improvement. RESULTS A total of 1 guideline, 1 evidence synthesis, 4 expert consensuses, 10 literature reviews, 2 diagnostic studies, and 9 case series were included in the best evidence. The early warning model including warning period, high-risk characteristics and early manifestation of TA-TMA was developed. The improvement action, including staff training and assessment, suspected TA-TMA identification and patient education, was implemented. The awareness and knowledge rate of early parameter of TA-TMA among nurses significantly improved after improvement action (100% vs. 26.7%, P < 0.001). The incidence of TA-TMA was similar among patients underwent HSCT before and after improvement action (2.8% vs. 1.2%, P = 0.643), while no fall event occurred after improvement action (0 vs. 1.2%, P < 0.001). CONCLUSION The evidence-based early warning model and healthcare quality improvement project could enhance the awareness and knowledge of TA-TMA among healthcare providers and might improve the prognosis of patients diagnosed with TA-TMA.
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Affiliation(s)
- Xiaoyu Zhou
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Yishan Ye
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Aiyun Jin
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Zhengwen Pan
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Zhe Xu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Shuyi Ding
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Jiali Yan
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Yin Cheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Yixuan Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Kai Cao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Wei Xie
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Jianli Zhang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Liwei Xu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Weiwei Zhou
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medical, Hangzhou, China.
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Lamloum D, Arghittu A, Ferrara P, Castiglia P, Dettori M, Gaeta M, Odone A, Campus G. A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist. Healthcare (Basel) 2023; 11:1895. [PMID: 37444729 DOI: 10.3390/healthcare11131895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as "Recommended", ranging from 56.3% to 84.3%, the others were described as "Recommended with modification", ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future.
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Affiliation(s)
- Demetrio Lamloum
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Antonella Arghittu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20126 Monza, Italy
- IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Paolo Castiglia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Marco Dettori
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Guglielmo Campus
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Department of Cariology, Saveetha Dental College and Hospitals, Chennai 600077, India
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Critical Appraisal of Guidelines for Antithrombotic Therapy in Atrial Fibrillation Post-Percutaneous Coronary Intervention. Glob Heart 2022; 17:14. [PMID: 35342701 PMCID: PMC8877875 DOI: 10.5334/gh.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Objective: In our present study, our objective was to appraise guidelines on antithrombotic therapy in atrial fibrillation post-percutaneous coronary intervention and to explore the differences in treatment practices for better informed decision-making. Methods: We searched for English language guidelines published between January 2000 and December 2020 at MEDLINE, Embase and websites of guideline organizations. Guidelines with recommendations on antithrombotic regimens for patients with AF undergoing PCI were included. Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was applied to assess guidelines. The reporting of conflicts of interest (COI) was evaluated separately by the RIGHT (Reporting Item for Practice Guidelines in Healthcare) checklist as supplementary items. Results: Sixteen guidelines were included, among which 13 (81.25%) were considered as ‘recommended’ and 1 (6.25%) as ‘unrecommended.’ The average scores of guidelines ranged from 55% to 88% (<60% as low quality, 60–70% as sufficient quality, and >70% as good quality). Among the 6 domains of AGREE II, scope and purpose (84%) and editorial independence(87%) were considered to be the fields in which CPGs performed best, evidenced by the highest mean AGREE II scores. The domains in which the reviewed CPGs received the lowest mean scores were stakeholder involvement (63%) and applicability (58%). The intraclass correlation coefficient scores were excellent in each domain. The overall quality of the selected CPGs was optimal, with the highest score in domain ‘scope and purpose’, and the lowest score in the domain ‘applicability.’ The reporting of COI was satisfactory. Conclusions: For the recommendations on antithrombotic strategies, guidelines with high AGREE II scores still exist discrepancy on the timing and selection. Current guidance documents on the treatment vary in methodological rigor and recommendations are not always consistent.
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Xie P, Zhuang X, Liu M, Zhang S, Liu J, Liu D, Liao X. An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis-the timing and mode of assessment (TTE or TEE). BMC Infect Dis 2021; 21:92. [PMID: 33478412 PMCID: PMC7819184 DOI: 10.1186/s12879-021-05785-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Echocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines. Methods A search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters. Results A total of 9 guidelines met the criteria, with AGREE II scores ranging from 36 to 79%, and the domain of “stakeholder involvement” received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence. Conclusions In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05785-6.
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Affiliation(s)
- Peihan Xie
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China.,Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China
| | - Shaozhao Zhang
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jia Liu
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Donghong Liu
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Xinxue Liao
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Shi L, Zhang Y, Zhang J, Gao Y, Liu J, Chen M, Yang X. Application of blood pre-albumin and NT-pro BNP levels in evaluating prognosis of elderly chronic heart failure patients. Exp Ther Med 2020; 20:1337-1342. [PMID: 32742368 PMCID: PMC7388205 DOI: 10.3892/etm.2020.8865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/03/2020] [Indexed: 12/28/2022] Open
Abstract
Levels of blood pre-albumin (PA) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) in elderly patients with chronic heart failure (CHF) and their clinical value in prognosis evaluation were explored. A total of 410 elderly patients aged ≥65 years hospitalized for CHF were enrolled. The concentrations of blood PA and NT-pro BNP, routine blood test and biochemistry indicators were determined and color Doppler echocardiography was performed. Additionally, the patients were followed up after discharge, and based on the occurrence of major adverse cardiac events (MACE), they were divided into MACE group and non-MACE group. MACE group had an older age and a higher level of plasma NT-pro BNP than non-MACE group (77.82±6.57) years vs. (76.39±6.18) years, and (8,864.52±9,718.36) pg/ml vs. (4,165.62+6,437.28) pg/ml (P<0.05), and the left ventricular ejection fraction and serum PA level in MACE group were lower than those in non-MACE group (P<0.05). According to the results of multivariate regression analysis, serum PA [odds ratio (OR)=0.242, 95% confidence interval (CI)=0.137-0.406, P<0.001] and plasma NT-pro BNP (OR=1.847, 95% CI=1.024-3.158, P=0.036) were independent risk factors for the occurrence of cardiac events during follow-up. Decline in PA level and elevation in NT-pro BNP level have a strong correlation with poor prognosis of elderly CHF patients, and they can be used for clinically evaluating disease conditions, guiding treatment and improving prognosis.
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Affiliation(s)
- Linying Shi
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Yuan Zhang
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Jing Zhang
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Yuanfeng Gao
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Jiamei Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Mulei Chen
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, P.R. China
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Zhang S, Zhou H, Zhuang X, Yang D, Sun X, Zhong X, Lin X, Hu X, Huang Y, Liao X, Du Z. Critical appraisal of guidelines for coronary artery disease on dual antiplatelet therapy: More consensus than controversies. Clin Cardiol 2019; 42:1170-1180. [PMID: 31609463 PMCID: PMC6906997 DOI: 10.1002/clc.23275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) in the form of aspirin plus a P2 Y12 inhibitor, when indicated, is one of the key treatments in coronary artery disease (CAD). Many recommendations on DAPT in patients with CAD based on current guidelines are largely inconsistent. In our current study, we aimed at systematically reviewing DAPT-relevant clinical practice guidelines, and highlighting their commonalities and differences for better informed decision-making. METHODS Contemporary guidelines in English were searched in MEDLINE, Embase and websites of guideline organizations and professional societies. Guidelines with recommendations on DAPT for CAD patients were included. Guideline quality was appraised with the 6-domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The reporting of conflicts of interest (COI) was assessed individually with supplementary items from the RIGHT (Reporting Item for Practice Guidelines in Healthcare) checklist. Meanwhile, extraction of recommendations was performed. RESULTS A total of 18 guidelines fulfilled our inclusion criteria. Most of them were graded with relatively good scores averaging from 42% to 74%. Domains for lower scores were in "stakeholder involvement" and "application." The reporting of COI was satisfactory. For the recommendations on DAPT, most guidelines with high AGREE II scores included consistent recommendations on the timing and P2 Y12 inhibitor selection. Nonetheless, conflicts still exist on the duration of DAPT. CONCLUSIONS Quality of guidelines for DAPT in CAD was relatively high, though defects existed in "Applicability" and "Stakeholder Involvement." As these guidelines developed, DAPT recommendations gradually converged on a consensus. Clinical decision should be made on an individual basis.
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Affiliation(s)
- Shaozhao Zhang
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Huimin Zhou
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Xiaodong Zhuang
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Daya Yang
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Xiuting Sun
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Xiangbin Zhong
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Xiaoyu Lin
- Department of AnesthesiologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Xun Hu
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Yiquan Huang
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Xinxue Liao
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
| | - Zhimin Du
- Cardiology DepartmentFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted CirculationSun Yat‐sen UniversityGuangzhouChina
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Zhou H, Zhang S, Sun X, Yang D, Zhuang X, Guo Y, Hu X, Du Z, Zhang M, Liao X. Lipid management for coronary heart disease patients: an appraisal of updated international guidelines applying Appraisal of Guidelines for Research and Evaluation II-clinical practice guideline appraisal for lipid management in coronary heart disease. J Thorac Dis 2019; 11:3534-3546. [PMID: 31559060 PMCID: PMC6753419 DOI: 10.21037/jtd.2019.07.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide many recommendations for hyperlipidemia management, but some of them are still debatable. METHODS We applied the six-domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate the quality of guidelines with lipid management recommendations for coronary heart disease (CHD), including dyslipidemia and CHD guidelines published from 2009 to 2019. Meanwhile, we synthesized and compared major recommendations and present the consistency and controversy in current dyslipidemia management. RESULTS Among 19 guidelines included, ten guidelines ("strongly recommended" with AGREE scores 61-94%) performed better than the other nine (38-65% as "recommended with some modification") For blood lipid tests, most CHD guidelines simply required fasting sample while dyslipidemia guidelines preferred non-fasting sample except in high triglycerides state. Most guidelines consistently chose low-density lipoprotein cholesterol (LDL-C) as the primary lipid-lowering target (LLT), while non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B were mainly selected as secondary LLTs. The specific goals of LDL-C lowering were either to lower than 70 mg/dL or with at least 50% reduction. All guidelines recommended high intensity or maximally tolerable doses of statins, while ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were recommended as second-line therapy. CONCLUSIONS The general quality of guidelines for lipid management is satisfactory. Consensus has been reached on the specific goal of lipid reduction and the intensity of statins therapy. Further research is needed to validate the application of non-fasting sample and non-HDL-C target, as well as the efficacy and safety of ezetimibe and PCSK9 inhibitors.
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Affiliation(s)
- Huimin Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiuting Sun
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
- Center for Information Technology & Statistics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xun Hu
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Zhimin Du
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
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