Small Target Group
The authors do not mention the Disease Management Programs (DMP) that are valid in Germany (DMP-Coronary Heart Disease [CHD; Koronare Herzkrankheit, KHK] or DMP-Diabetes), the National Health Care Guidelines (for diabetes or CHD), or the AWMF S3 Guideline on Cardiovascular Prevention of the German College of General Practitioners and Family Physicians (DEGAM) (1, 2). Instead, they cite mainly the guideline of the European Society of Cardiology (ESC) with high industrial dependence (3). Furthermore, if the intention is to refer to international recommendations for the wider medical profession, the ACP/AAFP Guidelines should have been mentioned (4), as these would inform the readers about which of the interventions are based on good data and strong recommendations, and which of the recommendations preferred by the authors represent actionism. In the inpatient area, disease prevalence and severity, as well as questions of liability and recourse, are quite different than in outpatient primary care or in the specialist area. For outpatient practices, many of the recommendations in the article are therefore neither evidence-based nor feasible. Since a principle of guidelines is that they should be compiled by a specific target group (and therefore can only be applied to it), it can be assumed that the ESC guideline—and subsequently also the article written by authors who work in hospitals—only applies for cardiologists working in hospitals. It remains unclear why a recommendation for such a small user group was not clearly indicated as such, but instead was even upgraded to a CME article.
Dr. med. Til Uebel and colleagues
Hausarztpraxen Ittlingen und Neckargemünd, Diabetologische Schwerpunktpraxis, Germany
Conflict of interest statement
Dr. Uebel is the medical leader of HD-MED Continuing Education and founding member of the Initiative for Pharma-Free Continuing Education in Germany.
|1.||Jordan J, Kurschat C, Reuter H: Arterial hypertension— diagnosis and treatment. Dtsch Arztebl Int 2018; 115: 557–68 VOLLTEXT|
|2.||DEGAM-S3-Leitlinie 2017: Hausärztliche Risikoberatung zur kardiovaskulären Prävention. www.awmf.org/leitlinien/detail/ll/053–024.html (last accessd on 1 September 2018).|
|3.||ESC-annual report 2017. www.escardio.org/static_file/Escardio/About%20the%20ESC/Annual-Reports/ESC-Annual-Report-2017.pdf (last accessd on 1 September 2018).|
|4.||Qaseem A, Wilt TJ, Rich R, et al.: Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2017; 166: 430–7 CrossRef MEDLINE|