Table 4.
Results of Consistency Analysis and Validation
| Type | Clinical Question | Consistency Analysis† | Validation | Comment |
| Consistencies | ||||
| (1) | Use of ACE inhibitors in systolic CHF, all NYHA classes (incl. asymptomatic patients NYHA class I, with or without history of myocardial infarction) | 16/16 'recommended' | Partly justified | Benefit was shown for symptomatic patients (all outcomes incl. mortality), in asymptomatic patients NYHA class I: improvement of prognosis and morbidity, but no evidence for a mortality reduction (see text) |
| Use of beta-blockers in systolic CHF, NYHA I post myocardial infarction | 11/11 'recommended' | Completely justified | Cited sources provided the reported evidence in form and content | |
| Use of beta-blockers in systolic CHF, NYHA II-III | 16/16 'recommended' | Completely justified | Cited sources provided the reported evidence in form and content | |
| (2) | Use of aldosterone antagonists in systolic CHF, NYHA III/IV | 16/16 'recommended' | Justified | Cited sources provided evidence on effectiveness; further research is needed on safety (see text) |
| Use of digoxin in systolic CHF with tachyarrhythmia | 15/15 'recommended' | Partly justified | Evidence level were revised (see text) | |
| Control of hypertension in diastolic CHF | 2/2 'recommended' | Not justified | Insufficient evidence, further research is needed (see text) | |
| Use of anticoagulants in patients with the combination of CHF and atrial fibrillation and/or a history of thromboembolism | 12/12 'recommended' | - | No re-assessment: recommendations referred to atrial fibrillation (out of scope in the target guideline) | |
| (4) | Exercise Training | 13/13 'recommended' | - | No re-assessment: evidence was to be found in a newly identified meta-analysis [63] |
| Diuretics in systolic CHF, NYHA II-IV | 14/14 'recommended' | Partly justified | Evidence level was revised (see text) | |
| Use of hydralazine plus ISDN in ACE inhibitor-/ARB-intolerant patients | 10/10 'recommended' | - | No re-assessment: no market availability for the fixed combination in the target context | |
| Harmlessness of long-acting dihydropyridines | 7/7 'recommended' | Partly justified | Evidence levels not justified; evidence insufficient, further research is needed | |
| Inconsistencies | ||||
| (B) | Salt and fluid restriction (varying quantification) | 9/10 'recommended', 1/10 'not recommended' | - | No validation: recommendations based on expert consensus |
| Beta-blockers in clinical stable systolic CHF, NYHA IV | 13/15 'recommended', 2/15 'not recommended' | Majority was justified, minority was rejected | Positive recommendations completely justified, negative recommendations based on insufficient evidence | |
| Beta-blockers in all systolic CHF, NYHA I – no matter whether post myocardial infarction or non-ischemic genesis | 7/8 'recommended', 1/8 'consideration recommended' | Majority was not justified, minority was accepted | No evidence for strong recommendation (see text) | |
| ARB in ACE intolerant patients | 15/16 'recommended', 1/16 potentially harmful therapy | Majority justified, minority rejected | Positive recommendations justified, negative recommendations based on insufficient evidence | |
†Numerical proportion of the mandating to guidelines which covered the scope and reported evidence levels and graded their recommendation. Type-3-consistencies – based on weak evidence – and type-A-inconsistencies are not listed in this table, as they were not included in the validation procedure but needed further research for evidence (a list is provided as additional web-based material, TABLE W5).