HISPANA | Directorio nacional de recursos digitales > Datos do registro

Está en:  › Datos do registro

Linked Open Data

2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention

Identificadores del recurso

Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.

1522-9645

https://hdl.handle.net/20.500.13003/24525

10.1093/eurheartj/ehaf009

40116721

Procedencia

(Docusalut. Repositorio institucional del sistema sanitario público de las Islas Baleares)

Ficha

Título:: 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention
Tema:: Guidelines; Level of evidence; Meta-analysis; Randomized controlled trial
Descrición:: The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.
Idioma:: English
Relación:: https://doi.org/10.1093/eurheartj/ehaf009
Autor/Productor:: Jüni, Peter; Antoniou, Sotiris; Arbelo, Elena; Buccheri, Sergio; Cikes, Maja; da Costa, Bruno R; Fauchier, Laurent; Gale, Chris P; Halvorsen, Sigrun; James, Stefan; Koskinas, Konstantinos C; Kotecha, Dipak; Landmesser, Ulf; Lewis, Basil S; Løchen, Maja-Lisa; Nielsen, Jens Cosedis; Rosselló, Xavier; Vaartjes, Ilonca; Prescott, Eva B; Baigent, Colin
Editor:: Oxford
Dereitos:: Attribution-NonCommercial-NoDerivatives 4.0 International; http://creativecommons.org/licenses/by-nc-nd/4.0/; open access
Data:: 2025-03-27T07:15:21Z; 2025-03-21
Tipo de recurso:: research article
Formato:: application/pdf

oai_dc

<?xml version="1.0" encoding="UTF-8" ?>

<oai_dc:dc schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
1. <dc:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</dc:title>
2. <dc:creator>Jüni, Peter</dc:creator>
3. <dc:creator>Antoniou, Sotiris</dc:creator>
4. <dc:creator>Arbelo, Elena</dc:creator>
5. <dc:creator>Buccheri, Sergio</dc:creator>
6. <dc:creator>Cikes, Maja</dc:creator>
7. <dc:creator>da Costa, Bruno R</dc:creator>
8. <dc:creator>Fauchier, Laurent</dc:creator>
9. <dc:creator>Gale, Chris P</dc:creator>
10. <dc:creator>Halvorsen, Sigrun</dc:creator>
11. <dc:creator>James, Stefan</dc:creator>
12. <dc:creator>Koskinas, Konstantinos C</dc:creator>
13. <dc:creator>Kotecha, Dipak</dc:creator>
14. <dc:creator>Landmesser, Ulf</dc:creator>
15. <dc:creator>Lewis, Basil S</dc:creator>
16. <dc:creator>Løchen, Maja-Lisa</dc:creator>
17. <dc:creator>Nielsen, Jens Cosedis</dc:creator>
18. <dc:creator>Rosselló, Xavier</dc:creator>
19. <dc:creator>Vaartjes, Ilonca</dc:creator>
20. <dc:creator>Prescott, Eva B</dc:creator>
21. <dc:creator>Baigent, Colin</dc:creator>
22. <dc:subject>Guidelines</dc:subject>
23. <dc:subject>Level of evidence</dc:subject>
24. <dc:subject>Meta-analysis</dc:subject>
25. <dc:subject>Randomized controlled trial</dc:subject>
26. <dc:description>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</dc:description>
27. <dc:date>2025-03-27T07:15:21Z</dc:date>
28. <dc:date>2025-03-27T07:15:21Z</dc:date>
29. <dc:date>2025-03-21</dc:date>
30. <dc:type>research article</dc:type>
31. <dc:identifier>Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</dc:identifier>
32. <dc:identifier>1522-9645</dc:identifier>
33. <dc:identifier>https://hdl.handle.net/20.500.13003/24525</dc:identifier>
34. <dc:identifier>10.1093/eurheartj/ehaf009</dc:identifier>
35. <dc:identifier>40116721</dc:identifier>
36. <dc:language>eng</dc:language>
37. <dc:relation>https://doi.org/10.1093/eurheartj/ehaf009</dc:relation>
38. <dc:rights>Attribution-NonCommercial-NoDerivatives 4.0 International</dc:rights>
39. <dc:rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</dc:rights>
40. <dc:rights>open access</dc:rights>
41. <dc:format>application/pdf</dc:format>
42. <dc:publisher>Oxford</dc:publisher>
</oai_dc:dc>

didl

<?xml version="1.0" encoding="UTF-8" ?>

<d:DIDL schemaLocation="urn:mpeg:mpeg21:2002:02-DIDL-NS http://standards.iso.org/ittf/PubliclyAvailableStandards/MPEG-21_schema_files/did/didl.xsd">
1. <d:DIDLInfo>
  1. <dcterms:created schemaLocation="http://purl.org/dc/terms/ http://dublincore.org/schemas/xmls/qdc/dcterms.xsd">2025-03-27T07:15:21Z</dcterms:created>
  </d:DIDLInfo>
2. <d:Item id="hdl_20.500.13003_24525">
  1. <d:Descriptor>
    1. <d:Statement mimeType="application/xml; charset=utf-8">
      1. <dii:Identifier schemaLocation="urn:mpeg:mpeg21:2002:01-DII-NS http://standards.iso.org/ittf/PubliclyAvailableStandards/MPEG-21_schema_files/dii/dii.xsd">urn:hdl:20.500.13003/24525</dii:Identifier>
      </d:Statement>
    </d:Descriptor>
  2. <d:Descriptor>
    1. <d:Statement mimeType="application/xml; charset=utf-8">
      1. <oai_dc:dc schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
        <dc:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</dc:title>
        <dc:creator>Jüni, Peter</dc:creator>
        <dc:creator>Antoniou, Sotiris</dc:creator>
        <dc:creator>Arbelo, Elena</dc:creator>
        <dc:creator>Buccheri, Sergio</dc:creator>
        <dc:creator>Cikes, Maja</dc:creator>
        <dc:creator>da Costa, Bruno R</dc:creator>
        <dc:creator>Fauchier, Laurent</dc:creator>
        <dc:creator>Gale, Chris P</dc:creator>
        <dc:creator>Halvorsen, Sigrun</dc:creator>
        <dc:creator>James, Stefan</dc:creator>
        <dc:creator>Koskinas, Konstantinos C</dc:creator>
        <dc:creator>Kotecha, Dipak</dc:creator>
        <dc:creator>Landmesser, Ulf</dc:creator>
        <dc:creator>Lewis, Basil S</dc:creator>
        <dc:creator>Løchen, Maja-Lisa</dc:creator>
        <dc:creator>Nielsen, Jens Cosedis</dc:creator>
        <dc:creator>Rosselló, Xavier</dc:creator>
        <dc:creator>Vaartjes, Ilonca</dc:creator>
        <dc:creator>Prescott, Eva B</dc:creator>
        <dc:creator>Baigent, Colin</dc:creator>
        <dc:description>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</dc:description>
        <dc:date>2025-03-27T07:15:21Z</dc:date>
        <dc:date>2025-03-27T07:15:21Z</dc:date>
        <dc:date>2025-03-21</dc:date>
        <dc:type>research article</dc:type>
        <dc:identifier>Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</dc:identifier>
        <dc:identifier>1522-9645</dc:identifier>
        <dc:identifier>https://hdl.handle.net/20.500.13003/24525</dc:identifier>
        <dc:identifier>10.1093/eurheartj/ehaf009</dc:identifier>
        <dc:identifier>40116721</dc:identifier>
        <dc:language>eng</dc:language>
        <dc:relation>https://doi.org/10.1093/eurheartj/ehaf009</dc:relation>
        <dc:rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</dc:rights>
        <dc:rights>open access</dc:rights>
        <dc:rights>Attribution-NonCommercial-NoDerivatives 4.0 International</dc:rights>
        <dc:publisher>Oxford</dc:publisher>
        </oai_dc:dc>
      </d:Statement>
    </d:Descriptor>
  3. <d:Component id="20.500.13003_24525_1">
    1. <d:Resource mimeType="application/pdf" ref="https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download" />
    </d:Component>
  </d:Item>
</d:DIDL>

dim

<?xml version="1.0" encoding="UTF-8" ?>

<dim:dim schemaLocation="http://www.dspace.org/xmlns/dspace/dim http://www.dspace.org/schema/dim.xsd">
1. <dim:field element="contributor" mdschema="dc" qualifier="author">Jüni, Peter</dim:field>
2. <dim:field element="contributor" mdschema="dc" qualifier="author">Antoniou, Sotiris</dim:field>
3. <dim:field element="contributor" mdschema="dc" qualifier="author">Arbelo, Elena</dim:field>
4. <dim:field element="contributor" mdschema="dc" qualifier="author">Buccheri, Sergio</dim:field>
5. <dim:field element="contributor" mdschema="dc" qualifier="author">Cikes, Maja</dim:field>
6. <dim:field element="contributor" mdschema="dc" qualifier="author">da Costa, Bruno R</dim:field>
7. <dim:field element="contributor" mdschema="dc" qualifier="author">Fauchier, Laurent</dim:field>
8. <dim:field element="contributor" mdschema="dc" qualifier="author">Gale, Chris P</dim:field>
9. <dim:field element="contributor" mdschema="dc" qualifier="author">Halvorsen, Sigrun</dim:field>
10. <dim:field element="contributor" mdschema="dc" qualifier="author">James, Stefan</dim:field>
11. <dim:field element="contributor" mdschema="dc" qualifier="author">Koskinas, Konstantinos C</dim:field>
12. <dim:field element="contributor" mdschema="dc" qualifier="author">Kotecha, Dipak</dim:field>
13. <dim:field element="contributor" mdschema="dc" qualifier="author">Landmesser, Ulf</dim:field>
14. <dim:field element="contributor" mdschema="dc" qualifier="author">Lewis, Basil S</dim:field>
15. <dim:field element="contributor" mdschema="dc" qualifier="author">Løchen, Maja-Lisa</dim:field>
16. <dim:field element="contributor" mdschema="dc" qualifier="author">Nielsen, Jens Cosedis</dim:field>
17. <dim:field authority="virtual::61" confidence="-1" element="contributor" mdschema="dc" qualifier="author">Rosselló, Xavier</dim:field>
18. <dim:field element="contributor" mdschema="dc" qualifier="author">Vaartjes, Ilonca</dim:field>
19. <dim:field element="contributor" mdschema="dc" qualifier="author">Prescott, Eva B</dim:field>
20. <dim:field element="contributor" mdschema="dc" qualifier="author">Baigent, Colin</dim:field>
21. <dim:field element="date" mdschema="dc" qualifier="accessioned">2025-03-27T07:15:21Z</dim:field>
22. <dim:field element="date" mdschema="dc" qualifier="available">2025-03-27T07:15:21Z</dim:field>
23. <dim:field element="date" mdschema="dc" qualifier="issued">2025-03-21</dim:field>
24. <dim:field element="identifier" mdschema="dc" qualifier="citation">Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</dim:field>
25. <dim:field element="identifier" mdschema="dc" qualifier="issn">1522-9645</dim:field>
26. <dim:field element="identifier" mdschema="dc" qualifier="uri">https://hdl.handle.net/20.500.13003/24525</dim:field>
27. <dim:field element="identifier" mdschema="dc" qualifier="doi">10.1093/eurheartj/ehaf009</dim:field>
28. <dim:field element="identifier" mdschema="dc" qualifier="pmid">40116721</dim:field>
29. <dim:field element="description" mdschema="dc" qualifier="abstract">The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</dim:field>
30. <dim:field element="language" mdschema="dc" qualifier="iso">eng</dim:field>
31. <dim:field element="publisher" mdschema="dc">Oxford</dim:field>
32. <dim:field element="rights" lang="en" mdschema="dc">Attribution-NonCommercial-NoDerivatives 4.0 International</dim:field>
33. <dim:field element="rights" mdschema="dc" qualifier="uri">http://creativecommons.org/licenses/by-nc-nd/4.0/</dim:field>
34. <dim:field element="rights" mdschema="dc" qualifier="accessRights">open access</dim:field>
35. <dim:field element="title" mdschema="dc">2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</dim:field>
36. <dim:field element="type" mdschema="dc">research article</dim:field>
37. <dim:field element="journal" mdschema="dc" qualifier="title">European Heart Journal</dim:field>
38. <dim:field element="relation" mdschema="dc" qualifier="publisherversion">https://doi.org/10.1093/eurheartj/ehaf009</dim:field>
39. <dim:field element="subject" mdschema="dc" qualifier="keyword">Guidelines</dim:field>
40. <dim:field element="subject" mdschema="dc" qualifier="keyword">Level of evidence</dim:field>
41. <dim:field element="subject" mdschema="dc" qualifier="keyword">Meta-analysis</dim:field>
42. <dim:field element="subject" mdschema="dc" qualifier="keyword">Randomized controlled trial</dim:field>
43. <dim:field element="entity" mdschema="dspace" qualifier="type">Publication</dim:field>
44. <dim:field authority="virtual::61" confidence="-1" element="isAuthorOfPublication" mdschema="relation">daf65357-a82d-423c-abdf-0cf17ab0c959</dim:field>
45. <dim:field authority="virtual::61" confidence="-1" element="isAuthorOfPublication" mdschema="relation" qualifier="latestForDiscovery">daf65357-a82d-423c-abdf-0cf17ab0c959</dim:field>
</dim:dim>

etdms

<?xml version="1.0" encoding="UTF-8" ?>

<thesis schemaLocation="http://www.ndltd.org/standards/metadata/etdms/1.0/ http://www.ndltd.org/standards/metadata/etdms/1.0/etdms.xsd">
1. <title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</title>
2. <creator>Jüni, Peter</creator>
3. <creator>Antoniou, Sotiris</creator>
4. <creator>Arbelo, Elena</creator>
5. <creator>Buccheri, Sergio</creator>
6. <creator>Cikes, Maja</creator>
7. <creator>da Costa, Bruno R</creator>
8. <creator>Fauchier, Laurent</creator>
9. <creator>Gale, Chris P</creator>
10. <creator>Halvorsen, Sigrun</creator>
11. <creator>James, Stefan</creator>
12. <creator>Koskinas, Konstantinos C</creator>
13. <creator>Kotecha, Dipak</creator>
14. <creator>Landmesser, Ulf</creator>
15. <creator>Lewis, Basil S</creator>
16. <creator>Løchen, Maja-Lisa</creator>
17. <creator>Nielsen, Jens Cosedis</creator>
18. <creator>Rosselló, Xavier</creator>
19. <creator>Vaartjes, Ilonca</creator>
20. <creator>Prescott, Eva B</creator>
21. <creator>Baigent, Colin</creator>
22. <description>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</description>
23. <date>2025-03-27</date>
24. <date>2025-03-27</date>
25. <date>2025-03-21</date>
26. <type>research article</type>
27. <identifier>Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</identifier>
28. <identifier>1522-9645</identifier>
29. <identifier>https://hdl.handle.net/20.500.13003/24525</identifier>
30. <identifier>10.1093/eurheartj/ehaf009</identifier>
31. <identifier>40116721</identifier>
32. <language>eng</language>
33. <relation>https://doi.org/10.1093/eurheartj/ehaf009</relation>
34. <rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</rights>
35. <rights>open access</rights>
36. <rights>Attribution-NonCommercial-NoDerivatives 4.0 International</rights>
37. <publisher>Oxford</publisher>
</thesis>

marc

<?xml version="1.0" encoding="UTF-8" ?>

<record schemaLocation="http://www.loc.gov/MARC21/slim http://www.loc.gov/standards/marcxml/schema/MARC21slim.xsd">
1. <leader>00925njm 22002777a 4500</leader>
2. <datafield ind1=" " ind2=" " tag="042">
  1. <subfield code="a">dc</subfield>
  </datafield>
3. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Jüni, Peter</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
4. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Antoniou, Sotiris</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
5. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Arbelo, Elena</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
6. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Buccheri, Sergio</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
7. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Cikes, Maja</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
8. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">da Costa, Bruno R</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
9. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Fauchier, Laurent</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
10. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Gale, Chris P</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
11. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Halvorsen, Sigrun</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
12. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">James, Stefan</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
13. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Koskinas, Konstantinos C</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
14. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Kotecha, Dipak</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
15. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Landmesser, Ulf</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
16. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Lewis, Basil S</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
17. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Løchen, Maja-Lisa</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
18. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Nielsen, Jens Cosedis</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
19. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Rosselló, Xavier</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
20. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Vaartjes, Ilonca</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
21. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Prescott, Eva B</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
22. <datafield ind1=" " ind2=" " tag="720">
  1. <subfield code="a">Baigent, Colin</subfield>
  2. <subfield code="e">author</subfield>
  </datafield>
23. <datafield ind1=" " ind2=" " tag="260">
  1. <subfield code="c">2025-03-21</subfield>
  </datafield>
24. <datafield ind1=" " ind2=" " tag="520">
  1. <subfield code="a">The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</subfield>
  </datafield>
25. <datafield ind1="8" ind2=" " tag="024">
  1. <subfield code="a">Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</subfield>
  </datafield>
26. <datafield ind1="8" ind2=" " tag="024">
  1. <subfield code="a">1522-9645</subfield>
  </datafield>
27. <datafield ind1="8" ind2=" " tag="024">
  1. <subfield code="a">https://hdl.handle.net/20.500.13003/24525</subfield>
  </datafield>
28. <datafield ind1="8" ind2=" " tag="024">
  1. <subfield code="a">10.1093/eurheartj/ehaf009</subfield>
  </datafield>
29. <datafield ind1="8" ind2=" " tag="024">
  1. <subfield code="a">40116721</subfield>
  </datafield>
30. <datafield ind1="0" ind2="0" tag="245">
  1. <subfield code="a">2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</subfield>
  </datafield>
</record>

mets

<?xml version="1.0" encoding="UTF-8" ?>

<mets ID=" DSpace_ITEM_20.500.13003-24525" OBJID=" hdl:20.500.13003/24525" PROFILE="DSpace METS SIP Profile 1.0" TYPE="DSpace ITEM" schemaLocation="http://www.loc.gov/METS/ http://www.loc.gov/standards/mets/mets.xsd">
1. <metsHdr CREATEDATE="2025-03-30T00:24:23Z">
  1. <agent ROLE="CUSTODIAN" TYPE="ORGANIZATION">
    1. <name>Docusalut</name>
    </agent>
  </metsHdr>
2. <dmdSec ID="DMD_20.500.13003_24525">
  1. <mdWrap MDTYPE="MODS">
    1. <xmlData schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-1.xsd">
      1. <mods:mods schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-1.xsd">
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Jüni, Peter</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Antoniou, Sotiris</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Arbelo, Elena</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Buccheri, Sergio</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Cikes, Maja</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>da Costa, Bruno R</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Fauchier, Laurent</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Gale, Chris P</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Halvorsen, Sigrun</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>James, Stefan</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Koskinas, Konstantinos C</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Kotecha, Dipak</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Landmesser, Ulf</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Lewis, Basil S</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Løchen, Maja-Lisa</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Nielsen, Jens Cosedis</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Rosselló, Xavier</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Vaartjes, Ilonca</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Prescott, Eva B</mods:namePart>
        </mods:name>
        <mods:name>
        <mods:role>
        <mods:roleTerm type="text">author</mods:roleTerm>
        </mods:role>
        <mods:namePart>Baigent, Colin</mods:namePart>
        </mods:name>
        <mods:extension>
        <mods:dateAccessioned encoding="iso8601">2025-03-27T07:15:21Z</mods:dateAccessioned>
        </mods:extension>
        <mods:extension>
        <mods:dateAvailable encoding="iso8601">2025-03-27T07:15:21Z</mods:dateAvailable>
        </mods:extension>
        <mods:originInfo>
        <mods:dateIssued encoding="iso8601">2025-03-21</mods:dateIssued>
        </mods:originInfo>
        <mods:identifier type="citation">Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</mods:identifier>
        <mods:identifier type="issn">1522-9645</mods:identifier>
        <mods:identifier type="uri">https://hdl.handle.net/20.500.13003/24525</mods:identifier>
        <mods:identifier type="doi">10.1093/eurheartj/ehaf009</mods:identifier>
        <mods:identifier type="pmid">40116721</mods:identifier>
        <mods:abstract>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</mods:abstract>
        <mods:language>
        <mods:languageTerm authority="rfc3066">eng</mods:languageTerm>
        </mods:language>
        <mods:accessCondition type="useAndReproduction">Attribution-NonCommercial-NoDerivatives 4.0 International</mods:accessCondition>
        <mods:titleInfo>
        <mods:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</mods:title>
        </mods:titleInfo>
        <mods:genre>research article</mods:genre>
        </mods:mods>
      </xmlData>
    </mdWrap>
  </dmdSec>
3. <amdSec ID="TMD_20.500.13003_24525">
  1. <rightsMD ID="RIG_20.500.13003_24525">
    1. <mdWrap MDTYPE="OTHER" MIMETYPE="text/plain" OTHERMDTYPE="DSpaceDepositLicense">
      1. <binData>UGFyYSBxdWUgZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQgcHVlZGEgYWxtYWNlbmFyIHkgZGlzdHJpYnVpciBlbCBtYXRlcmlhbCBkZXBvc2l0YWRvLCBlcyBuZWNlc2FyaW8gcXVlIHF1aWVuIHJlYWxpemEgZWwgZGVww7NzaXRvIGxlYSB5IGFjZXB0ZSBsb3MgdMOpcm1pbm9zIGVzdGFibGVjaWRvcyBlbiBlc3RhIGxpY2VuY2lhLgoKQWNlcHRhbmRvIGVzdGEgbGljZW5jaWEsIHVzdGVkLCBjb21vIGF1dG9yL2EgbyBwcm9waWV0YXJpby9hIGRlbCBjb3B5cmlnaHQsIGNlZGUgYSBsYSBDb25zZWxsZXJpYSBkZSBTYWx1dCBpIENvbnN1bSBkZWwgR292ZXJuIGRlIGxlcyBJbGxlcyBCYWxlYXJzLCBkZSBmb3JtYSBncmF0dWl0YSB5IG5vIGV4Y2x1c2l2YSwgbG9zIGRlcmVjaG9zIGRlIHJlcHJvZHVjY2nDs24sIGRpc3RyaWJ1Y2nDs24sIGNvbXVuaWNhY2nDs24gcMO6YmxpY2EgeSB0cmFuc2Zvcm1hY2nDs24gc29icmUgZGljaG8gbWF0ZXJpYWwsIHBlcm1pdGllbmRvIHF1ZSBzZSBwb25nYSBhIGRpc3Bvc2ljacOzbiBkZSB0ZXJjZXJvcyB1c3VhcmlvcyBkZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQsIGNvbiBsb3MgdXNvcyBwZXJtaXRpZG9zIHkgY29uZGljaW9uZXMgZXN0YWJsZWNpZG9zIGVuIGVzdGEgbGljZW5jaWEuIAoKVXN0ZWQgYWNlcHRhIHF1ZSBsYSBDb25zZWxsZXJpYSBwdWVkYSwgc2luIGFsdGVyYXIgZWwgY29udGVuaWRvLCB0cmFuc2Zvcm1hciB5L28gYWRhcHRhciBlbCBtYXRlcmlhbCBkZXBvc2l0YWRvIGVuIERvY3VzYWx1dCBhIGN1YWxxdWllciBvdHJvIGZvcm1hdG8sIGVuIGxhIG1lZGlkYSBxdWUgcmVzdWx0ZSBuZWNlc2FyaW8sIGNvbiBmaW5lcyBkZSBwcmVzZXJ2YWNpw7NuIHkgYWNjZXNpYmlsaWRhZC4gSWd1YWxtZW50ZSBhY2VwdGEgcXVlIGxhIENvbnNlbGxlcmlhIHB1ZWRhIGNvbnNlcnZhciBtw6FzIGRlIHVuYSBjb3BpYSBkZWwgbWF0ZXJpYWwgZGVwb3NpdGFkbywgYSBmaW4gZGUgcmVhbGl6YXIgY29waWFzIGRlIHNlZ3VyaWRhZCB5IHByZXNlcnZhciBlbCBtYXRlcmlhbCBwYXJhIGVsIGZ1dHVyby4KClVzdGVkIGRlY2xhcmEgcXVlIGVsIG1hdGVyaWFsIGRlcG9zaXRhZG8gZXMgdW5hIG9icmEgb3JpZ2luYWwgZGUgc3UgY3JlYWNpw7NuIHkgb3N0ZW50YSBsYSB0aXR1bGFyaWRhZCBkZSBkZXJlY2hvcyBkZSBhdXRvciBuZWNlc2FyaWEgcGFyYSBvdG9yZ2FyIGxhIGNlc2nDs24gY29udGVuaWRhIGVuIGxhIHByZXNlbnRlIGxpY2VuY2lhLiBFbiBjYXNvIGRlIGNvdGl0dWxhcmlkYWQsIHVzdGVkIG1hbmlmaWVzdGEgcXVlIGVzdMOhIGFjdHVhbmRvIHRhbWJpw6luIGVuIHJlcHJlc2VudGFjacOzbiBkZSBsb3Mgb3Ryb3MgY29hdXRvcmVzLiBFbiBjb25zZWN1ZW5jaWEsIHVzdGVkIGFzZWd1cmEgeSBnYXJhbnRpemEgcXVlIGVsIG1hdGVyaWFsIHF1ZSBkZXBvc2l0YSBlbiBlbCByZXBvc2l0b3JpbyBpbnN0aXR1Y2lvbmFsIERvY3VzYWx1dCBubyBpbmZyaW5nZSBuaW5nw7puIGRlcmVjaG8gZGUgY29weXJpZ2h0LgoKQ29tbyBnYXJhbnRlIGRlIGxhIGF1dG9yw61hIGRlIGxhIG9icmEgeSBjb24gcmVsYWNpw7NuIGEgbGEgbWlzbWEsIHVzdGVkIGRlY2xhcmEgcXVlIGxhIENvbnNlbGxlcmlhIGRlIFNhbHV0IGkgQ29uc3VtIGRlbCBHb3Zlcm4gZGUgbGVzIElsbGVzIEJhbGVhcnMgc2UgZW5jdWVudHJhIGxpYnJlIGRlIHRvZG8gdGlwbyBkZSByZXNwb25zYWJpbGlkYWQsIHNlYSBjaXZpbCwgYWRtaW5pc3RyYXRpdmEgbyBwZW5hbCAoaW5jbHVpZG8gZWwgcGxhZ2lvKSwgeSB1c3RlZCBhc3VtZSBsYSByZXNwb25zYWJpbGlkYWQgZnJlbnRlIGEgY3VhbHF1aWVyIHJlY2xhbWFjacOzbiBvIGRlbWFuZGEgcG9yIHBhcnRlIGRlIHRlcmNlcm9zIGRlIG1hbmVyYSBleGNsdXNpdmEuCgpEb2N1c2FsdXQgaWRlbnRpZmljYXLDoSBjbGFyYW1lbnRlIGVsIG5vbWJyZSBkZSBsb3MgYXV0b3JlcyBvIHRpdHVsYXJlcyBkZSBsYSBvYnJhIGRlcG9zaXRhZGEsIHkgbm8gZWZlY3R1YXLDoSBtw6FzIGFsdGVyYWNpb25lcyBlbiBkaWNobyBtYXRlcmlhbCBxdWUgbGFzIGV4cHJlc2FtZW50ZSBwZXJtaXRpZGFzIHBvciBlc3RhIGxpY2VuY2lhLiBVc3RlZCBwb2Ryw6Egc29saWNpdGFyLCBwb3IgY2F1c2EganVzdGlmaWNhZGEgeSBhY3JlZGl0YWRhIHBvciBlc2NyaXRvIGFudGUgZWwgYWRtaW5pc3RyYWRvciBkZSBkaWNobyByZXBvc2l0b3JpbywgbGEgcmV0aXJhZGEgZGUgbGEgb2JyYSBkZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQuIERlIGlndWFsIG1vZG8sIERvY3VzYWx1dCBwb2Ryw6EgcmV0aXJhciBlbCBtYXRlcmlhbCBlbiBzdXB1ZXN0b3Mgc3VmaWNpZW50ZW1lbnRlIGp1c3RpZmljYWRvcywgbyBlbiBjYXNvIGRlIHJlY2xhbWFjaW9uZXMgZGUgdGVyY2Vyb3MuIFVzdGVkIHNlcsOhIGNvbnZlbmllbnRlbWVudGUgbm90aWZpY2Fkby9hIGRlIGN1YWxxdWllciByZWNsYW1hY2nDs24gcXVlIHB1ZWRhbiBmb3JtdWxhciB0ZXJjZXJhcyBwZXJzb25hcyBlbiByZWxhY2nDs24gY29uIGxhIG9icmEgeSwgZW4gcGFydGljdWxhciwgZGUgcmVjbGFtYWNpb25lcyByZWxhdGl2YXMgYSBsb3MgZGVyZWNob3MgZGUgcHJvcGllZGFkIGludGVsZWN0dWFsIHNvYnJlIGVsbGEuCg==</binData>
      </mdWrap>
    </rightsMD>
  </amdSec>
4. <amdSec ID="FO_20.500.13003_24525_1">
  1. <techMD ID="TECH_O_20.500.13003_24525_1">
    1. <mdWrap MDTYPE="PREMIS">
      1. <xmlData schemaLocation="http://www.loc.gov/standards/premis http://www.loc.gov/standards/premis/PREMIS-v1-0.xsd">
        <premis:premis>
        <premis:object>
        <premis:objectIdentifier>
        <premis:objectIdentifierType>URL</premis:objectIdentifierType>
        <premis:objectIdentifierValue>https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download</premis:objectIdentifierValue>
        </premis:objectIdentifier>
        <premis:objectCategory>File</premis:objectCategory>
        <premis:objectCharacteristics>
        <premis:fixity>
        <premis:messageDigestAlgorithm>MD5</premis:messageDigestAlgorithm>
        <premis:messageDigest>9a37e1d60e9fe446a260157ace8e1b81</premis:messageDigest>
        </premis:fixity>
        <premis:size>282739</premis:size>
        <premis:format>
        <premis:formatDesignation>
        <premis:formatName>application/pdf</premis:formatName>
        </premis:formatDesignation>
        </premis:format>
        </premis:objectCharacteristics>
        <premis:originalName>Eur-Heart-J-2025_03_21.pdf</premis:originalName>
        </premis:object>
        </premis:premis>
        </xmlData>
      </mdWrap>
    </techMD>
  </amdSec>
5. <fileSec>
  1. <fileGrp USE="ORIGINAL">
    1. <file ADMID="FO_20.500.13003_24525_1" CHECKSUM="9a37e1d60e9fe446a260157ace8e1b81" CHECKSUMTYPE="MD5" GROUPID="GROUP_BITSTREAM_20.500.13003_24525_1" ID="BITSTREAM_ORIGINAL_20.500.13003_24525_1" MIMETYPE="application/pdf" SEQ="1" SIZE="282739">
      1. <FLocat LOCTYPE="URL" href="https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download" type="simple" />
      </file>
    </fileGrp>
  </fileSec>
6. <structMap LABEL="DSpace Object" TYPE="LOGICAL">
  1. <div ADMID="DMD_20.500.13003_24525" TYPE="DSpace Object Contents">
    1. <div TYPE="DSpace BITSTREAM">
      1. <fptr FILEID="BITSTREAM_ORIGINAL_20.500.13003_24525_1" />
      </div>
    </div>
  </structMap>
</mets>

mods

<?xml version="1.0" encoding="UTF-8" ?>

<mods:mods schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-1.xsd">
1. <mods:name>
  1. <mods:namePart>Jüni, Peter</mods:namePart>
  </mods:name>
2. <mods:name>
  1. <mods:namePart>Antoniou, Sotiris</mods:namePart>
  </mods:name>
3. <mods:name>
  1. <mods:namePart>Arbelo, Elena</mods:namePart>
  </mods:name>
4. <mods:name>
  1. <mods:namePart>Buccheri, Sergio</mods:namePart>
  </mods:name>
5. <mods:name>
  1. <mods:namePart>Cikes, Maja</mods:namePart>
  </mods:name>
6. <mods:name>
  1. <mods:namePart>da Costa, Bruno R</mods:namePart>
  </mods:name>
7. <mods:name>
  1. <mods:namePart>Fauchier, Laurent</mods:namePart>
  </mods:name>
8. <mods:name>
  1. <mods:namePart>Gale, Chris P</mods:namePart>
  </mods:name>
9. <mods:name>
  1. <mods:namePart>Halvorsen, Sigrun</mods:namePart>
  </mods:name>
10. <mods:name>
  1. <mods:namePart>James, Stefan</mods:namePart>
  </mods:name>
11. <mods:name>
  1. <mods:namePart>Koskinas, Konstantinos C</mods:namePart>
  </mods:name>
12. <mods:name>
  1. <mods:namePart>Kotecha, Dipak</mods:namePart>
  </mods:name>
13. <mods:name>
  1. <mods:namePart>Landmesser, Ulf</mods:namePart>
  </mods:name>
14. <mods:name>
  1. <mods:namePart>Lewis, Basil S</mods:namePart>
  </mods:name>
15. <mods:name>
  1. <mods:namePart>Løchen, Maja-Lisa</mods:namePart>
  </mods:name>
16. <mods:name>
  1. <mods:namePart>Nielsen, Jens Cosedis</mods:namePart>
  </mods:name>
17. <mods:name>
  1. <mods:namePart>Rosselló, Xavier</mods:namePart>
  </mods:name>
18. <mods:name>
  1. <mods:namePart>Vaartjes, Ilonca</mods:namePart>
  </mods:name>
19. <mods:name>
  1. <mods:namePart>Prescott, Eva B</mods:namePart>
  </mods:name>
20. <mods:name>
  1. <mods:namePart>Baigent, Colin</mods:namePart>
  </mods:name>
21. <mods:extension>
  1. <mods:dateAvailable encoding="iso8601">2025-03-27T07:15:21Z</mods:dateAvailable>
  </mods:extension>
22. <mods:extension>
  1. <mods:dateAccessioned encoding="iso8601">2025-03-27T07:15:21Z</mods:dateAccessioned>
  </mods:extension>
23. <mods:originInfo>
  1. <mods:dateIssued encoding="iso8601">2025-03-21</mods:dateIssued>
  </mods:originInfo>
24. <mods:identifier type="citation">Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</mods:identifier>
25. <mods:identifier type="issn">1522-9645</mods:identifier>
26. <mods:identifier type="uri">https://hdl.handle.net/20.500.13003/24525</mods:identifier>
27. <mods:identifier type="doi">10.1093/eurheartj/ehaf009</mods:identifier>
28. <mods:identifier type="pmid">40116721</mods:identifier>
29. <mods:abstract>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</mods:abstract>
30. <mods:language>
  1. <mods:languageTerm>eng</mods:languageTerm>
  </mods:language>
31. <mods:accessCondition type="useAndReproduction">http://creativecommons.org/licenses/by-nc-nd/4.0/</mods:accessCondition>
32. <mods:accessCondition type="useAndReproduction">open access</mods:accessCondition>
33. <mods:accessCondition type="useAndReproduction">Attribution-NonCommercial-NoDerivatives 4.0 International</mods:accessCondition>
34. <mods:titleInfo>
  1. <mods:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</mods:title>
  </mods:titleInfo>
35. <mods:genre>research article</mods:genre>
</mods:mods>

ore

<?xml version="1.0" encoding="UTF-8" ?>

<atom:entry schemaLocation="http://www.w3.org/2005/Atom http://www.kbcafe.com/rss/atom.xsd.xml">
1. <atom:id>https://hdl.handle.net/20.500.13003/24525/ore.xml</atom:id>
2. <atom:link href="https://hdl.handle.net/20.500.13003/24525" rel="alternate" />
3. <atom:link href="https://hdl.handle.net/20.500.13003/24525/ore.xml" rel="http://www.openarchives.org/ore/terms/describes" />
4. <atom:link href="https://hdl.handle.net/20.500.13003/24525/ore.xml#atom" rel="self" type="application/atom+xml" />
5. <atom:published>2025-03-27T07:15:21Z</atom:published>
6. <atom:updated>2025-03-27T07:15:21Z</atom:updated>
7. <atom:source>
  1. <atom:generator>Docusalut</atom:generator>
  </atom:source>
8. <atom:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</atom:title>
9. <atom:author>
  1. <atom:name>Jüni, Peter</atom:name>
  </atom:author>
10. <atom:author>
  1. <atom:name>Antoniou, Sotiris</atom:name>
  </atom:author>
11. <atom:author>
  1. <atom:name>Arbelo, Elena</atom:name>
  </atom:author>
12. <atom:author>
  1. <atom:name>Buccheri, Sergio</atom:name>
  </atom:author>
13. <atom:author>
  1. <atom:name>Cikes, Maja</atom:name>
  </atom:author>
14. <atom:author>
  1. <atom:name>da Costa, Bruno R</atom:name>
  </atom:author>
15. <atom:author>
  1. <atom:name>Fauchier, Laurent</atom:name>
  </atom:author>
16. <atom:author>
  1. <atom:name>Gale, Chris P</atom:name>
  </atom:author>
17. <atom:author>
  1. <atom:name>Halvorsen, Sigrun</atom:name>
  </atom:author>
18. <atom:author>
  1. <atom:name>James, Stefan</atom:name>
  </atom:author>
19. <atom:author>
  1. <atom:name>Koskinas, Konstantinos C</atom:name>
  </atom:author>
20. <atom:author>
  1. <atom:name>Kotecha, Dipak</atom:name>
  </atom:author>
21. <atom:author>
  1. <atom:name>Landmesser, Ulf</atom:name>
  </atom:author>
22. <atom:author>
  1. <atom:name>Lewis, Basil S</atom:name>
  </atom:author>
23. <atom:author>
  1. <atom:name>Løchen, Maja-Lisa</atom:name>
  </atom:author>
24. <atom:author>
  1. <atom:name>Nielsen, Jens Cosedis</atom:name>
  </atom:author>
25. <atom:author>
  1. <atom:name>Rosselló, Xavier</atom:name>
  </atom:author>
26. <atom:author>
  1. <atom:name>Vaartjes, Ilonca</atom:name>
  </atom:author>
27. <atom:author>
  1. <atom:name>Prescott, Eva B</atom:name>
  </atom:author>
28. <atom:author>
  1. <atom:name>Baigent, Colin</atom:name>
  </atom:author>
29. <atom:category label="Aggregation" scheme="http://www.openarchives.org/ore/terms/" term="http://www.openarchives.org/ore/terms/Aggregation" />
30. <atom:category scheme="http://www.openarchives.org/ore/atom/modified" term="2025-03-27T07:15:21Z" />
31. <atom:category label="DSpace Item" scheme="http://www.dspace.org/objectModel/" term="DSpaceItem" />
32. <atom:link href="https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download" length="282739" rel="http://www.openarchives.org/ore/terms/aggregates" title="Eur-Heart-J-2025_03_21.pdf" type="application/pdf" />
33. <oreatom:triples>
  1. <rdf:Description about="https://hdl.handle.net/20.500.13003/24525/ore.xml#atom">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceItem" />
    2. <dcterms:modified>2025-03-27T07:15:21Z</dcterms:modified>
    </rdf:Description>
  2. <rdf:Description about="https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceBitstream" />
    2. <dcterms:description>ORIGINAL</dcterms:description>
    </rdf:Description>
  3. <rdf:Description about="https://docusalut.com/bitstreams/880111ad-e038-4ab5-90f0-a7214da04de3/download">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceBitstream" />
    2. <dcterms:description>CC-LICENSE</dcterms:description>
    </rdf:Description>
  4. <rdf:Description about="https://docusalut.com/bitstreams/40c3f55d-8993-4b11-9acf-c5c4477f181c/download">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceBitstream" />
    2. <dcterms:description>LICENSE</dcterms:description>
    </rdf:Description>
  5. <rdf:Description about="https://docusalut.com/bitstreams/35aa28cc-d810-4219-9ab8-9db249979b00/download">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceBitstream" />
    2. <dcterms:description>LICENSE</dcterms:description>
    </rdf:Description>
  6. <rdf:Description about="https://docusalut.com/bitstreams/e13589fb-a01b-4738-884d-477a4f6bf0fd/download">
    1. <rdf:type resource="http://www.dspace.org/objectModel/DSpaceBitstream" />
    2. <dcterms:description>THUMBNAIL</dcterms:description>
    </rdf:Description>
  </oreatom:triples>
</atom:entry>

qdc

<?xml version="1.0" encoding="UTF-8" ?>

<qdc:qualifieddc schemaLocation="http://purl.org/dc/elements/1.1/ http://dublincore.org/schemas/xmls/qdc/2006/01/06/dc.xsd http://purl.org/dc/terms/ http://dublincore.org/schemas/xmls/qdc/2006/01/06/dcterms.xsd http://dspace.org/qualifieddc/ http://www.ukoln.ac.uk/metadata/dcmi/xmlschema/qualifieddc.xsd">
1. <dc:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</dc:title>
2. <dc:creator>Jüni, Peter</dc:creator>
3. <dc:creator>Antoniou, Sotiris</dc:creator>
4. <dc:creator>Arbelo, Elena</dc:creator>
5. <dc:creator>Buccheri, Sergio</dc:creator>
6. <dc:creator>Cikes, Maja</dc:creator>
7. <dc:creator>da Costa, Bruno R</dc:creator>
8. <dc:creator>Fauchier, Laurent</dc:creator>
9. <dc:creator>Gale, Chris P</dc:creator>
10. <dc:creator>Halvorsen, Sigrun</dc:creator>
11. <dc:creator>James, Stefan</dc:creator>
12. <dc:creator>Koskinas, Konstantinos C</dc:creator>
13. <dc:creator>Kotecha, Dipak</dc:creator>
14. <dc:creator>Landmesser, Ulf</dc:creator>
15. <dc:creator>Lewis, Basil S</dc:creator>
16. <dc:creator>Løchen, Maja-Lisa</dc:creator>
17. <dc:creator>Nielsen, Jens Cosedis</dc:creator>
18. <dc:creator>Rosselló, Xavier</dc:creator>
19. <dc:creator>Vaartjes, Ilonca</dc:creator>
20. <dc:creator>Prescott, Eva B</dc:creator>
21. <dc:creator>Baigent, Colin</dc:creator>
22. <dcterms:abstract>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</dcterms:abstract>
23. <dcterms:dateAccepted>2025-03-27T07:15:21Z</dcterms:dateAccepted>
24. <dcterms:available>2025-03-27T07:15:21Z</dcterms:available>
25. <dcterms:created>2025-03-27T07:15:21Z</dcterms:created>
26. <dcterms:issued>2025-03-21</dcterms:issued>
27. <dc:type>research article</dc:type>
28. <dc:identifier>Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</dc:identifier>
29. <dc:identifier>1522-9645</dc:identifier>
30. <dc:identifier>https://hdl.handle.net/20.500.13003/24525</dc:identifier>
31. <dc:identifier>10.1093/eurheartj/ehaf009</dc:identifier>
32. <dc:identifier>40116721</dc:identifier>
33. <dc:language>eng</dc:language>
34. <dc:relation>https://doi.org/10.1093/eurheartj/ehaf009</dc:relation>
35. <dc:rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</dc:rights>
36. <dc:rights>open access</dc:rights>
37. <dc:rights>Attribution-NonCommercial-NoDerivatives 4.0 International</dc:rights>
38. <dc:publisher>Oxford</dc:publisher>
</qdc:qualifieddc>

rdf

<?xml version="1.0" encoding="UTF-8" ?>

<rdf:RDF schemaLocation="http://www.openarchives.org/OAI/2.0/rdf/ http://www.openarchives.org/OAI/2.0/rdf.xsd">
1. <ow:Publication about="oai:docusalut.com:20.500.13003/24525">
  1. <dc:title>2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</dc:title>
  2. <dc:creator>Jüni, Peter</dc:creator>
  3. <dc:creator>Antoniou, Sotiris</dc:creator>
  4. <dc:creator>Arbelo, Elena</dc:creator>
  5. <dc:creator>Buccheri, Sergio</dc:creator>
  6. <dc:creator>Cikes, Maja</dc:creator>
  7. <dc:creator>da Costa, Bruno R</dc:creator>
  8. <dc:creator>Fauchier, Laurent</dc:creator>
  9. <dc:creator>Gale, Chris P</dc:creator>
  10. <dc:creator>Halvorsen, Sigrun</dc:creator>
  11. <dc:creator>James, Stefan</dc:creator>
  12. <dc:creator>Koskinas, Konstantinos C</dc:creator>
  13. <dc:creator>Kotecha, Dipak</dc:creator>
  14. <dc:creator>Landmesser, Ulf</dc:creator>
  15. <dc:creator>Lewis, Basil S</dc:creator>
  16. <dc:creator>Løchen, Maja-Lisa</dc:creator>
  17. <dc:creator>Nielsen, Jens Cosedis</dc:creator>
  18. <dc:creator>Rosselló, Xavier</dc:creator>
  19. <dc:creator>Vaartjes, Ilonca</dc:creator>
  20. <dc:creator>Prescott, Eva B</dc:creator>
  21. <dc:creator>Baigent, Colin</dc:creator>
  22. <dc:description>The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</dc:description>
  23. <dc:date>2025-03-27T07:15:21Z</dc:date>
  24. <dc:date>2025-03-27T07:15:21Z</dc:date>
  25. <dc:date>2025-03-21</dc:date>
  26. <dc:type>research article</dc:type>
  27. <dc:identifier>Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</dc:identifier>
  28. <dc:identifier>1522-9645</dc:identifier>
  29. <dc:identifier>https://hdl.handle.net/20.500.13003/24525</dc:identifier>
  30. <dc:identifier>10.1093/eurheartj/ehaf009</dc:identifier>
  31. <dc:identifier>40116721</dc:identifier>
  32. <dc:language>eng</dc:language>
  33. <dc:relation>https://doi.org/10.1093/eurheartj/ehaf009</dc:relation>
  34. <dc:rights>http://creativecommons.org/licenses/by-nc-nd/4.0/</dc:rights>
  35. <dc:rights>open access</dc:rights>
  36. <dc:rights>Attribution-NonCommercial-NoDerivatives 4.0 International</dc:rights>
  37. <dc:publisher>Oxford</dc:publisher>
  </ow:Publication>
</rdf:RDF>

xoai

<?xml version="1.0" encoding="UTF-8" ?>

<metadata schemaLocation="http://www.lyncode.com/xoai http://www.lyncode.com/xsd/xoai.xsd">
1. <element name="dc">
  1. <element name="contributor">
    1. <element name="author">
      1. <element name="none">
        <field name="value">Jüni, Peter</field>
        <field name="value">Antoniou, Sotiris</field>
        <field name="value">Arbelo, Elena</field>
        <field name="value">Buccheri, Sergio</field>
        <field name="value">Cikes, Maja</field>
        <field name="value">da Costa, Bruno R</field>
        <field name="value">Fauchier, Laurent</field>
        <field name="value">Gale, Chris P</field>
        <field name="value">Halvorsen, Sigrun</field>
        <field name="value">James, Stefan</field>
        <field name="value">Koskinas, Konstantinos C</field>
        <field name="value">Kotecha, Dipak</field>
        <field name="value">Landmesser, Ulf</field>
        <field name="value">Lewis, Basil S</field>
        <field name="value">Løchen, Maja-Lisa</field>
        <field name="value">Nielsen, Jens Cosedis</field>
        <field name="value">Rosselló, Xavier</field>
        <field name="authority">virtual::61</field>
        <field name="confidence">-1</field>
        <field name="value">Vaartjes, Ilonca</field>
        <field name="value">Prescott, Eva B</field>
        <field name="value">Baigent, Colin</field>
        </element>
      </element>
    </element>
  2. <element name="date">
    1. <element name="accessioned">
      1. <element name="none">
        <field name="value">2025-03-27T07:15:21Z</field>
        </element>
      </element>
    2. <element name="available">
      1. <element name="none">
        <field name="value">2025-03-27T07:15:21Z</field>
        </element>
      </element>
    3. <element name="issued">
      1. <element name="none">
        <field name="value">2025-03-21</field>
        </element>
      </element>
    </element>
  3. <element name="identifier">
    1. <element name="citation">
      1. <element name="none">
        <field name="value">Jüni P, Antoniou S, Arbelo E, Buccheri S, Cikes M, da Costa BR, et al. 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. Eur Heart J. 2025 Mar 21.</field>
        </element>
      </element>
    2. <element name="issn">
      1. <element name="none">
        <field name="value">1522-9645</field>
        </element>
      </element>
    3. <element name="uri">
      1. <element name="none">
        <field name="value">https://hdl.handle.net/20.500.13003/24525</field>
        </element>
      </element>
    4. <element name="doi">
      1. <element name="none">
        <field name="value">10.1093/eurheartj/ehaf009</field>
        </element>
      </element>
    5. <element name="pmid">
      1. <element name="none">
        <field name="value">40116721</field>
        </element>
      </element>
    </element>
  4. <element name="description">
    1. <element name="abstract">
      1. <element name="none">
        <field name="value">The level of evidence (LOE) grading system for ESC Clinical Practice Guidelines classifies the quality of the evidence supporting a recommendation. However, the current taxonomy does not fully consider the optimal study design necessary to establish evidence for such recommendations. Therefore, two separate taskforces of clinical and methodological experts were appointed by the Clinical Practice Guidelines Committee, with the first tasked with updating the LOE grading system for therapy and prevention, and the second responsible for developing a LOE grading system for diagnosis and prediction. The updated system for therapy and prevention presented here maintains the three-level grading structure but uses revised definitions. Level of evidence A represents conclusive evidence usually from ≥2 adequately powered randomized controlled trials (RCTs) free from major bias, with substantial evidence against the play of chance when combined in a meta-analysis (e.g. P < .005 for superiority). Additional criteria are specified to define substantial evidence against the play of chance in case of non-inferiority, equivalence, and harm. Level of evidence B is now subdivided into B1 and B2. Level of evidence B1 represents suggestive evidence usually from ≥1 adequately powered RCT free from major bias, or a meta-analysis of such RCTs, with some evidence against the play of chance (e.g. P < .05 for superiority). Level of evidence B2 represents limited evidence from ≥2 adequately powered non-randomized studies with careful control of major sources of bias or from a meta-analysis of small, underpowered RCTs. Level of evidence C represents preliminary evidence from either non-randomized studies without careful control of major sources of bias, a single small, underpowered RCT, or expert consensus.</field>
        </element>
      </element>
    </element>
  5. <element name="language">
    1. <element name="iso">
      1. <element name="none">
        <field name="value">eng</field>
        </element>
      </element>
    </element>
  6. <element name="publisher">
    1. <element name="none">
      1. <field name="value">Oxford</field>
      </element>
    </element>
  7. <element name="rights">
    1. <element name="en">
      1. <field name="value">Attribution-NonCommercial-NoDerivatives 4.0 International</field>
      </element>
    2. <element name="uri">
      1. <element name="none">
        <field name="value">http://creativecommons.org/licenses/by-nc-nd/4.0/</field>
        </element>
      </element>
    3. <element name="accessRights">
      1. <element name="none">
        <field name="value">open access</field>
        </element>
      </element>
    </element>
  8. <element name="title">
    1. <element name="none">
      1. <field name="value">2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention</field>
      </element>
    </element>
  9. <element name="type">
    1. <element name="none">
      1. <field name="value">research article</field>
      </element>
    </element>
  10. <element name="journal">
    1. <element name="title">
      1. <element name="none">
        <field name="value">European Heart Journal</field>
        </element>
      </element>
    </element>
  11. <element name="relation">
    1. <element name="publisherversion">
      1. <element name="none">
        <field name="value">https://doi.org/10.1093/eurheartj/ehaf009</field>
        </element>
      </element>
    </element>
  12. <element name="subject">
    1. <element name="keyword">
      1. <element name="none">
        <field name="value">Guidelines</field>
        <field name="value">Level of evidence</field>
        <field name="value">Meta-analysis</field>
        <field name="value">Randomized controlled trial</field>
        </element>
      </element>
    </element>
  </element>
2. <element name="dspace">
  1. <element name="entity">
    1. <element name="type">
      1. <element name="none">
        <field name="value">Publication</field>
        </element>
      </element>
    </element>
  </element>
3. <element name="relation">
  1. <element name="isAuthorOfPublication">
    1. <element name="none">
      1. <field name="value">daf65357-a82d-423c-abdf-0cf17ab0c959</field>
      2. <field name="authority">virtual::61</field>
      3. <field name="confidence">-1</field>
      </element>
    2. <element name="latestForDiscovery">
      1. <element name="none">
        <field name="value">daf65357-a82d-423c-abdf-0cf17ab0c959</field>
        <field name="authority">virtual::61</field>
        <field name="confidence">-1</field>
        </element>
      </element>
    </element>
  </element>
4. <element name="bundles">
  1. <element name="bundle">
    1. <field name="name">ORIGINAL</field>
    2. <element name="bitstreams">
      1. <element name="bitstream">
        <field name="name">Eur-Heart-J-2025_03_21.pdf</field>
        <field name="originalName">Eur-Heart-J-2025_03_21.pdf</field>
        <field name="format">application/pdf</field>
        <field name="size">282739</field>
        <field name="url">https://docusalut.com/bitstreams/abcd3c4d-f1cd-4638-bab5-d84382dc171e/download</field>
        <field name="checksum">9a37e1d60e9fe446a260157ace8e1b81</field>
        <field name="checksumAlgorithm">MD5</field>
        <field name="sid">1</field>
        </element>
      </element>
    </element>
  2. <element name="bundle">
    1. <field name="name">CC-LICENSE</field>
    2. <element name="bitstreams">
      1. <element name="bitstream">
        <field name="name">license_rdf</field>
        <field name="originalName">license_rdf</field>
        <field name="format">application/rdf+xml; charset=utf-8</field>
        <field name="size">900</field>
        <field name="url">https://docusalut.com/bitstreams/880111ad-e038-4ab5-90f0-a7214da04de3/download</field>
        <field name="checksum">290956fd1c652a6a70f68df09f2d403b</field>
        <field name="checksumAlgorithm">MD5</field>
        <field name="sid">2</field>
        </element>
      </element>
    </element>
  3. <element name="bundle">
    1. <field name="name">LICENSE</field>
    2. <element name="bitstreams">
      1. <element name="bitstream">
        <field name="name">license.txt</field>
        <field name="originalName">license.txt</field>
        <field name="format">text/plain; charset=utf-8</field>
        <field name="size">2656</field>
        <field name="url">https://docusalut.com/bitstreams/40c3f55d-8993-4b11-9acf-c5c4477f181c/download</field>
        <field name="checksum">2950fb5652400e2aa8d1e74e7b3e66ca</field>
        <field name="checksumAlgorithm">MD5</field>
        <field name="sid">3</field>
        </element>
      2. <element name="bitstream">
        <field name="name">ARXIU DELEGAT</field>
        <field name="format">application/pdf</field>
        <field name="size">389463</field>
        <field name="url">https://docusalut.com/bitstreams/35aa28cc-d810-4219-9ab8-9db249979b00/download</field>
        <field name="checksum">8b5ea4c3afb41ff45c40ef60c9ff2984</field>
        <field name="checksumAlgorithm">MD5</field>
        <field name="sid">4</field>
        </element>
      </element>
    </element>
  4. <element name="bundle">
    1. <field name="name">THUMBNAIL</field>
    2. <element name="bitstreams">
      1. <element name="bitstream">
        <field name="name">Eur-Heart-J-2025_03_21.pdf.jpg</field>
        <field name="originalName">Eur-Heart-J-2025_03_21.pdf.jpg</field>
        <field name="description">IM Thumbnail</field>
        <field name="format">image/jpeg</field>
        <field name="size">8511</field>
        <field name="url">https://docusalut.com/bitstreams/e13589fb-a01b-4738-884d-477a4f6bf0fd/download</field>
        <field name="checksum">0cacecbaffc7e0575c85bc9a56746d1c</field>
        <field name="checksumAlgorithm">MD5</field>
        <field name="sid">5</field>
        </element>
      </element>
    </element>
  </element>
5. <element name="others">
  1. <field name="handle">20.500.13003/24525</field>
  2. <field name="identifier">oai:docusalut.com:20.500.13003/24525</field>
  3. <field name="lastModifyDate">2025-03-28 01:45:29.732</field>
  4. <element name="cc">
    1. <field name="uri">http://creativecommons.org/licenses/by-nc-nd/4.0/</field>
    2. <field name="name">Attribution-NonCommercial-NoDerivatives 4.0 International</field>
    </element>
  5. <element name="access-status">
    1. <field name="value">open.access</field>
    </element>
  </element>
6. <element name="repository">
  1. <field name="url">https://docusalut.com</field>
  2. <field name="name">Docusalut</field>
  3. <field name="mail">docusalut@bibliosalut.com</field>
  </element>
7. <element name="license">
  1. <field name="bin">UGFyYSBxdWUgZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQgcHVlZGEgYWxtYWNlbmFyIHkgZGlzdHJpYnVpciBlbCBtYXRlcmlhbCBkZXBvc2l0YWRvLCBlcyBuZWNlc2FyaW8gcXVlIHF1aWVuIHJlYWxpemEgZWwgZGVww7NzaXRvIGxlYSB5IGFjZXB0ZSBsb3MgdMOpcm1pbm9zIGVzdGFibGVjaWRvcyBlbiBlc3RhIGxpY2VuY2lhLgoKQWNlcHRhbmRvIGVzdGEgbGljZW5jaWEsIHVzdGVkLCBjb21vIGF1dG9yL2EgbyBwcm9waWV0YXJpby9hIGRlbCBjb3B5cmlnaHQsIGNlZGUgYSBsYSBDb25zZWxsZXJpYSBkZSBTYWx1dCBpIENvbnN1bSBkZWwgR292ZXJuIGRlIGxlcyBJbGxlcyBCYWxlYXJzLCBkZSBmb3JtYSBncmF0dWl0YSB5IG5vIGV4Y2x1c2l2YSwgbG9zIGRlcmVjaG9zIGRlIHJlcHJvZHVjY2nDs24sIGRpc3RyaWJ1Y2nDs24sIGNvbXVuaWNhY2nDs24gcMO6YmxpY2EgeSB0cmFuc2Zvcm1hY2nDs24gc29icmUgZGljaG8gbWF0ZXJpYWwsIHBlcm1pdGllbmRvIHF1ZSBzZSBwb25nYSBhIGRpc3Bvc2ljacOzbiBkZSB0ZXJjZXJvcyB1c3VhcmlvcyBkZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQsIGNvbiBsb3MgdXNvcyBwZXJtaXRpZG9zIHkgY29uZGljaW9uZXMgZXN0YWJsZWNpZG9zIGVuIGVzdGEgbGljZW5jaWEuIAoKVXN0ZWQgYWNlcHRhIHF1ZSBsYSBDb25zZWxsZXJpYSBwdWVkYSwgc2luIGFsdGVyYXIgZWwgY29udGVuaWRvLCB0cmFuc2Zvcm1hciB5L28gYWRhcHRhciBlbCBtYXRlcmlhbCBkZXBvc2l0YWRvIGVuIERvY3VzYWx1dCBhIGN1YWxxdWllciBvdHJvIGZvcm1hdG8sIGVuIGxhIG1lZGlkYSBxdWUgcmVzdWx0ZSBuZWNlc2FyaW8sIGNvbiBmaW5lcyBkZSBwcmVzZXJ2YWNpw7NuIHkgYWNjZXNpYmlsaWRhZC4gSWd1YWxtZW50ZSBhY2VwdGEgcXVlIGxhIENvbnNlbGxlcmlhIHB1ZWRhIGNvbnNlcnZhciBtw6FzIGRlIHVuYSBjb3BpYSBkZWwgbWF0ZXJpYWwgZGVwb3NpdGFkbywgYSBmaW4gZGUgcmVhbGl6YXIgY29waWFzIGRlIHNlZ3VyaWRhZCB5IHByZXNlcnZhciBlbCBtYXRlcmlhbCBwYXJhIGVsIGZ1dHVyby4KClVzdGVkIGRlY2xhcmEgcXVlIGVsIG1hdGVyaWFsIGRlcG9zaXRhZG8gZXMgdW5hIG9icmEgb3JpZ2luYWwgZGUgc3UgY3JlYWNpw7NuIHkgb3N0ZW50YSBsYSB0aXR1bGFyaWRhZCBkZSBkZXJlY2hvcyBkZSBhdXRvciBuZWNlc2FyaWEgcGFyYSBvdG9yZ2FyIGxhIGNlc2nDs24gY29udGVuaWRhIGVuIGxhIHByZXNlbnRlIGxpY2VuY2lhLiBFbiBjYXNvIGRlIGNvdGl0dWxhcmlkYWQsIHVzdGVkIG1hbmlmaWVzdGEgcXVlIGVzdMOhIGFjdHVhbmRvIHRhbWJpw6luIGVuIHJlcHJlc2VudGFjacOzbiBkZSBsb3Mgb3Ryb3MgY29hdXRvcmVzLiBFbiBjb25zZWN1ZW5jaWEsIHVzdGVkIGFzZWd1cmEgeSBnYXJhbnRpemEgcXVlIGVsIG1hdGVyaWFsIHF1ZSBkZXBvc2l0YSBlbiBlbCByZXBvc2l0b3JpbyBpbnN0aXR1Y2lvbmFsIERvY3VzYWx1dCBubyBpbmZyaW5nZSBuaW5nw7puIGRlcmVjaG8gZGUgY29weXJpZ2h0LgoKQ29tbyBnYXJhbnRlIGRlIGxhIGF1dG9yw61hIGRlIGxhIG9icmEgeSBjb24gcmVsYWNpw7NuIGEgbGEgbWlzbWEsIHVzdGVkIGRlY2xhcmEgcXVlIGxhIENvbnNlbGxlcmlhIGRlIFNhbHV0IGkgQ29uc3VtIGRlbCBHb3Zlcm4gZGUgbGVzIElsbGVzIEJhbGVhcnMgc2UgZW5jdWVudHJhIGxpYnJlIGRlIHRvZG8gdGlwbyBkZSByZXNwb25zYWJpbGlkYWQsIHNlYSBjaXZpbCwgYWRtaW5pc3RyYXRpdmEgbyBwZW5hbCAoaW5jbHVpZG8gZWwgcGxhZ2lvKSwgeSB1c3RlZCBhc3VtZSBsYSByZXNwb25zYWJpbGlkYWQgZnJlbnRlIGEgY3VhbHF1aWVyIHJlY2xhbWFjacOzbiBvIGRlbWFuZGEgcG9yIHBhcnRlIGRlIHRlcmNlcm9zIGRlIG1hbmVyYSBleGNsdXNpdmEuCgpEb2N1c2FsdXQgaWRlbnRpZmljYXLDoSBjbGFyYW1lbnRlIGVsIG5vbWJyZSBkZSBsb3MgYXV0b3JlcyBvIHRpdHVsYXJlcyBkZSBsYSBvYnJhIGRlcG9zaXRhZGEsIHkgbm8gZWZlY3R1YXLDoSBtw6FzIGFsdGVyYWNpb25lcyBlbiBkaWNobyBtYXRlcmlhbCBxdWUgbGFzIGV4cHJlc2FtZW50ZSBwZXJtaXRpZGFzIHBvciBlc3RhIGxpY2VuY2lhLiBVc3RlZCBwb2Ryw6Egc29saWNpdGFyLCBwb3IgY2F1c2EganVzdGlmaWNhZGEgeSBhY3JlZGl0YWRhIHBvciBlc2NyaXRvIGFudGUgZWwgYWRtaW5pc3RyYWRvciBkZSBkaWNobyByZXBvc2l0b3JpbywgbGEgcmV0aXJhZGEgZGUgbGEgb2JyYSBkZWwgcmVwb3NpdG9yaW8gaW5zdGl0dWNpb25hbCBEb2N1c2FsdXQuIERlIGlndWFsIG1vZG8sIERvY3VzYWx1dCBwb2Ryw6EgcmV0aXJhciBlbCBtYXRlcmlhbCBlbiBzdXB1ZXN0b3Mgc3VmaWNpZW50ZW1lbnRlIGp1c3RpZmljYWRvcywgbyBlbiBjYXNvIGRlIHJlY2xhbWFjaW9uZXMgZGUgdGVyY2Vyb3MuIFVzdGVkIHNlcsOhIGNvbnZlbmllbnRlbWVudGUgbm90aWZpY2Fkby9hIGRlIGN1YWxxdWllciByZWNsYW1hY2nDs24gcXVlIHB1ZWRhbiBmb3JtdWxhciB0ZXJjZXJhcyBwZXJzb25hcyBlbiByZWxhY2nDs24gY29uIGxhIG9icmEgeSwgZW4gcGFydGljdWxhciwgZGUgcmVjbGFtYWNpb25lcyByZWxhdGl2YXMgYSBsb3MgZGVyZWNob3MgZGUgcHJvcGllZGFkIGludGVsZWN0dWFsIHNvYnJlIGVsbGEuCg==</field>
  </element>
</metadata>