1999 Resident Poster Competition
Paul K. Crane M.D.
Washington University
Evaluating Guidelines for Coronary Heart Disease in Women
Introduction: Coronary heart disease is the leading cause of death in women. However, the prevalence of coronary heart disease is lower for women at every age than is the prevalence in men. This lower prevalence makes the predictive values of any diagnostic test for coronary artery disease lower in women than in men. This project evaluated the various guidelines that have been promulgated to determine how successfully they navigate the difficult issues of prevalence and predictive value.
Methods: Review of articles and textbooks that discussed the evaluation of coronary heart disease specifically in women were identified. References from these works were obtained. These references were then reviewed using pre-established criteria for methodologic adequacy and size of experimental groups, and each reference was graded on five point scale. Discussions of evaluation of coronary heart disease in women were then assessed based on the grade of evidence each utilized.
Results: A wide spectrum of references were identified, spanning from well conducted large trials with a clearly defined gold standard, to references to individual expert opinion. Guidelines on the evaluation of coronary disease in women varied widely in the strength of evidence they utilized to arrive at their recommendations.
Conclusions: A certain degree of skepticism is appropriate when approaching practice guidelines. Seemingly authoritative discussions of a topic may be based on less-than-optimal data. Complicated and intricate areas of the medical literature such as the evaluation of heart disease in women serve to highlight the rather varied statistical savvy and critical evaluation of the medical literature found in writers of guidelines.
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
