Aplicación del Grade en las recomendaciones de meta-análisis en red en la guía Colombiana de falla cardíaca

Juan Manuel Senior, Juan Manuel Toro-Escobar, Clara Inés Saldarriaga-Giraldo

Resumen


Introducción: los metaanálisis en red (MAR) permiten incorporar y analizar comparaciones indirectas entre intervenciones y son una ayuda para la elaboración de recomendaciones en las guías de práctica clínica. El objetivo de este artículo es resumir la revisión bibliográfica que realizó el grupo sobre MAR, las recomendaciones del grupo GRADE para evaluarlos y la forma como se elaboró la recomendación para esta pregunta de la la guía.

Metodología: para la pregunta sobre el uso de betabloqueadores (BB) en pacientes con síndrome de falla cardíaca clasificación C de la ACC/AHA se hizo una búsqueda sistemática. Se encontró un MAR, que resumía los hallazgos para responderla, con el cual se describe la aplicación de GRADE en este tipo de estudios.

Resultados: el resultado global del metaanálisis mostró una reducción significativa de la mortalidad con el uso de BB contra cualquier comparador; todas son comparaciones indirectas excepto el estudio de carvedilol contra metoprolol tartrato. Todos los BB mostraron reducción de la mortalidad, pero no hubo significancia estadística cuando se compararon entre ellos. Este MAR no publicó la probabilidad en el orden de tratamiento y el análisis de las características generales de los estudios incluidos en él no mostró intransitividad; además, la comparación entre metoprolol y carvedilol demostró coherencia de la comparación directa y la indirecta.

Conclusión: Los MAR son una forma de resumir la evidencia disponible incluyendo comparaciones indirectas, tienen una metodología particular y los criterios del grupo GRADE son prácticos y aplicables como mostramos se hizo en el desarrollo de esta guía de práctica clínica.


Palabras clave


Guía; Insuficiencia Cardíaca; Metaanálisis

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Referencias


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