Using Clinical Guidelines to Assess the Potential Value of Laboratory Medicine in Clinical Decision-Making
Background: It is often quoted that 70% of clinical decisions are based on laboratory results although there is a lack of evidence to substantiate this claim. The aim of this review was to review all CVD guidelines published by five leading authority bodies and to determine to the proportion that recommended laboratory testing.
Materials and Methods: This study examined all guidelines associated with cardiovascular disease (CVD), released by the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ). Each document was evaluated for clinical recommendations for laboratory investigation.
Results: In total 101 guidelines were reviewed with 24 of the 33 ESC guidelines relating to CVD and 15 of the 20 NICE guidelines relating to CVD, made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. For of their CVD guidelines, while laboratory testing featured in 25/32 of the ACC and 15/16 of the AHF/ CSANZ guidelines.
Conclusions: This study shows that five of the most prominent authorities for cardiovascular disease state a requirement for the use of laboratory testing in an average of 78% of their guidelines. This shows that the contribution laboratory medicine provide to the diagnosis of CVD is underestimated.
Keywords - Cardiovascular Disease, Clinical Guidelines, Pathology Testing.