The natural history of guidelines: The case of aortopathy related to bicuspid aortic valves

Abstract

Clinical guidelines represent statements that seek to synthesize the best evidence to guide a course of action to improve health outcomes and more cost-effective use of resources. However, even when the evidence is not definitive, comprehensive documents are still needed to guide clinical decision-making. In these circumstances, guidelines are inevitably affected by perceptions of the problem and their possible solutions. From 1998 to 2014, 10 different international guidelines have focused on the aortopathy related to bicuspid aortic valves. Recommended thresholds for intervention started at a cutoff level of 5.5 cm in 1998, reached a nadir of 4 to 4.5 cm in 2010, and returned to a 5.5 cm c..