"There are lots of issues raised by this discussion," Gardner said. "To us, it is a validation of the usefulness of guidelines, plus pointing out that we don't have as many multi-center randomized trials as we would like to have."
But existing guidelines, Gardner said, are basically the best that can be set at this time. "As we get into more areas of medical science and patient care, sometimes we get into areas where there are not primary clinical trials," he said. "When guidelines are based on clinical trials, which is as good evidence as can be obtained, they can be trusted quite enthusiastically. When we are forced to rely on expert opinion, we need to respect the fact that future trials may provide further information."
The report carries a plea for more government support of clinical research, Tricoci said, a view supported in a statement from Dr. W. Douglas Weaver, head of cardiovascular medicine at Henry Ford Hospital in Detroit and president of the American College of Cardiology.
"We must continue to diligently apply the best evidence available, but we need more research," Weaver said. "This paper is a valuable and important message to the new administration, Congress and the nation about the need to invest more in science, medical evidence and clinical comparative effectiveness."
Heart-related scientific statements and practice guidelines are available from the American Heart Association.
SOURCES: Timothy J. Gardner, M.D., director, Center for Heart & Vascular Health, Christiana Health Care System, New Castle, Del., and president, American Heart Association; Pierluigi Tricoci, M.D., cardiologist, Duke Heart Center, Duke University, Durham, N.C.; Feb. 25, 2009, Journal of the American Medical Association