Article Figures & Data
Figures
- Fig 1.
Frequency of any financial conflict of interest among guideline committee members. AF = atrial fibrillation; HF = heart failure; IHD = myocardial revascularisation; PD = pericardial diseases; VHD = valvular heart disease.
- Fig 2.
Percentage of authors with a financial conflict of interest with the study funder by guideline and level of evidence. AF = atrial fibrillation; HF = heart failure; IHD = myocardial revascularisation; PD = pericardial diseases; VHD = valvular heart disease.
Tables
- Box 1.
Types of financial conflict of interest with the pharmaceutical industry as defined by the European Society of Cardiology
Direct personal payment Payment to institution Receipt of royalty for intellectual property Research funding (departmental/institutional) Research funding (personal) - Table 1.
Breakdown of the type of financial conflict of interest for guideline committee members
Guideline Committee member n Direct personal payment (%) Payment to their institution (%) Royalty from intellectual property (%) Research funding (departmental/institutional) (%) Research funding (personal) (%) IHD Authors 25 68 28 0 60 8 Reviewers 32 69 34 3 50 3 AF Authors 17 82 41 0 47 0 Reviewers 33 76 42 6 41 3 PD Authors 18 22 0 0 28 6 Reviewers 31 10 0 0 13 0 VHD Authors 18 72 39 6 17 0 Reviewers 34 75 32 0 24 0 HF Authors 21 76 38 0 52 0 Reviewers 42 76 31 2 50 2 AF = atrial fibrillation; HF = heart failure; IHD = myocardial revascularisation; PD = pericardial diseases; VHD = valvular heart disease.
- Table 2.
Classification of conflict of interest and action taken in the American College of Physicians’ guidance for management of competing interests among guideline authors17
Level of CoI Definition Management of CoI High Any active relationship (financial or otherwise) with a high-risk entity, which the CGC defines as an entity that has a direct financial stake in the clinical conclusions of a guideline or guidance statement. Option 1: participant discontinues association if they are willing and able to do so (eg sell off stock in a pharmaceutical company). Once inactive, high-level COIs downgraded to low-level as opportunity for direct financial benefit has been eliminated. Option 2: if participant is unwilling or unable to release the interest, they are restricted from involvement in guideline development (participation in discussions, voting on recommendations and authorship). Option 3: participant may resign from the committee. Moderate Most frequently an intellectual interest that is clinically relevant to the guideline topic. Intellectual CoIs are previously formed conclusions that may leave a clinical guideline vulnerable to cognitive biases (eg confirmation bias or authority bias) and may result in indirect financial benefit related to career advancement. Partial restriction: may participate in discussions but restricted from voting and authorship (recognised as a non-author contributor in final document). Low Intellectual interest only tangentially related to guideline topic or a previous high-level CoI which is now inactive No restrictions: may participate in discussions, serve as an author and vote on recommendations. CGC = Clinical Guidelines Committee; CoI = conflict of interest.
Summary
What is known? Medical guidelines define clinical practice and, as such, have substantial implications for clinicians, patients, healthcare providers and the pharmaceutical industry.
Industry spends large amounts of money on relationships with the healthcare community. Furthermore, evidence suggests that clinicians are likely to change their prescribing habits as a result of these relationships.
What is the question? How much influence does industry have upon the content of clinical guidelines in cardiology?
There were two key aims of this study:
to evaluate the frequency of conflicts of interest among the clinicians involved in the production of five ESC guidelines
to examine the role of industry in producing the evidence used to support the pharmaceutical recommendations in these guidelines.
What was found? Across five clinical practice guidelines from the ESC, guideline authors frequently had a relevant CoI, particularly direct personal payments.
The evidence used to support the pharmaceutical recommendations was often supported by industry-funded studies.
Authors of industry-funded studies frequently had a conflict of interest with the study funder.
What is the implication for practice now? Given that there are experts without relevant CoIs, we suggest that all guideline committees adopt an approach similar to NICE in preventing clinicians with relevant CoIs from serving on guideline development committees.
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