指南
卵圆孔未闭
医学
心理干预
报销
分级(工程)
多学科方法
循证医学
循证实践
循证管理
重症监护医学
系统回顾
家庭医学
梅德林
替代医学
护理部
偏头痛
病理
医疗保健
内科学
土木工程
工程类
经济
经济增长
社会科学
社会学
政治学
法学
作者
Clifford J. Kavinsky,Molly Szerlip,Andrew M. Goldsweig,Zahid Amin,Konstantinos Dean Boudoulas,John D. Carroll,Megan Coylewright,Sammy Elmariah,Lee A. MacDonald,Atman P. Shah,Christian Spies,Jonathan M. Tobis,Steven R. Messé,Emily Senerth,Yngve Falck‐Ytter,Ifeoluwa Babatunde,Rebecca L. Morgan
标识
DOI:10.1016/j.jscai.2022.100039
摘要
Abstract
Background
Patent foramen ovale (PFO) is a vestigial congenital cardiovascular structure present in around 25% of adults. In most cases, PFO is entirely benign and requires no treatment. However, it may cause serious complications under certain circumstances. Objective
These evidence-based guidelines from the Society for Cardiovascular Angiography and Interventions (SCAI) aim to support patients, clinicians, and other stakeholders in decisions about management of PFO. Methods
SCAI convened a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for the guideline-development process. Following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the guideline panel formulated and prioritized clinical questions in population, intervention, comparison, outcome (PICO) format. A separate technical review team of clinical and methodological experts conducted systematic reviews of the evidence, synthesized data, and graded the certainty of the evidence across outcomes. The guideline panel then reconvened to formulate recommendations and supporting remarks informed by the results of the technical review and additional contextual factors described in the GRADE evidence-to-decision framework. Results
The panel agreed on 13 recommendations to address variations on 5 clinical scenarios. Conclusions
Key recommendations address patient selection for PFO closure in the prevention of recurrent PFO-associated stroke, including populations not commonly included in randomized studies, and scenarios where the PFO closure might serve a role in the prevention of other outcomes such as migraine headaches and decompression illness. The panel has also identified future research priorities to advance the field.
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