Table 4 Results of Consistency Analysis and Validation

(1)

Use of ACE inhibitors in systolic CHF, all NYHA classes (incl. asymptomatic patients NYHA class I, with or without history of myocardial infarction)

16/16 'recommended'

Partly justified

Benefit was shown for symptomatic patients (all outcomes incl. mortality), in asymptomatic patients NYHA class I: improvement of prognosis and morbidity, but no evidence for a mortality reduction (see text)

Use of beta-blockers in systolic CHF, NYHA I post myocardial infarction

11/11 'recommended'

Completely justified

Cited sources provided the reported evidence in form and content

Use of beta-blockers in systolic CHF, NYHA II-III

16/16 'recommended'

Completely justified

Cited sources provided the reported evidence in form and content

(2)

Use of aldosterone antagonists in systolic CHF, NYHA III/IV

16/16 'recommended'

Justified

Cited sources provided evidence on effectiveness; further research is needed on safety (see text)

Use of digoxin in systolic CHF with tachyarrhythmia

15/15 'recommended'

Partly justified

Evidence level were revised (see text)

Control of hypertension in diastolic CHF

2/2 'recommended'

Not justified

Insufficient evidence, further research is needed (see text)

Use of anticoagulants in patients with the combination of CHF and atrial fibrillation and/or a history of thromboembolism

12/12 'recommended'

-

No re-assessment: recommendations referred to atrial fibrillation (out of scope in the target guideline)

(4)

Exercise Training

13/13 'recommended'

-

No re-assessment: evidence was to be found in a newly identified meta-analysis [63]

Diuretics in systolic CHF, NYHA II-IV

14/14 'recommended'

Partly justified

Evidence level was revised (see text)

Use of hydralazine plus ISDN in ACE inhibitor-/ARB-intolerant patients

10/10 'recommended'

-

No re-assessment: no market availability for the fixed combination in the target context

Harmlessness of long-acting dihydropyridines

7/7 'recommended'

Partly justified

Evidence levels not justified; evidence insufficient, further research is needed

Inconsistencies

(B)

Salt and fluid restriction (varying quantification)

9/10 'recommended', 1/10 'not recommended'

-

No validation: recommendations based on expert consensus

Beta-blockers in clinical stable systolic CHF, NYHA IV

13/15 'recommended', 2/15 'not recommended'

Majority was justified, minority was rejected

Positive recommendations completely justified, negative recommendations based on insufficient evidence

Beta-blockers in all systolic CHF, NYHA I – no matter whether post myocardial infarction or non-ischemic genesis

7/8 'recommended', 1/8 'consideration recommended'

Majority was not justified, minority was accepted

No evidence for strong recommendation (see text)

ARB in ACE intolerant patients

15/16 'recommended', 1/16 potentially harmful therapy

Majority justified, minority rejected

Positive recommendations justified, negative recommendations based on insufficient evidence