2021 ESC/EACTS Guidelines for the management of valvular heart disease, engl.

Year of publication: 2021

Editing medical society(ies):
European Society of Cardiology (ESC)

Other medical societies involved: 6

Evaluation by Leitlinienwatch






The conflicts of interest have been documented (https://www.escardio.org/static-file/Escardio/Guidelines/DOI/DOI_Summary_2021_VHD_ehab395.pdf). This is followed by an analysis of the COI declarations on the basis of the "ESC declaration of interest rules" (p. 565 f.) without any discernible result.


Composition of the Guideline Working Group

The guideline group is divided into "Members", where all 21 members have declared conflicts of interest. In the "Reviewers" group, 43 reported conflicts of interest and 38 none, and in the "Clinical Practice Guidelines Committee 2020-2022", 26 out of 31 members reported conflicts of interest (https://www.escardio.org/static-file/Escardio/Guidelines/DOI/DOI_Summary_2021_VHD_ehab395.pdf). Our rating refers to the "Members".


Independence of the Coordinators/Chairs/Lead AuthorsUnabhängigkeit der Vorsitzenden/federführenden Autoren

Both the ESC and EACTS chairs have indicated conflicts of interest. 18 out of 18 task force coordinators also report conflicts of interest.


Abstention from Voting


External Review of the Guideline

On page 565 of the guideline, it is stated that all ESC guidelines are reviewed by the Clinical Practice Guidelines Committee and unspecified "external experts". It is unclear who these external experts are, but in the CPG committee, 21 out of 31 members have indicated conflicts of interest. There is no description of the consultation of the draft guideline by the professional public, patients or a documented handling of the suggestions received.


Bonus Points

According to the ESC, for the first time, a "methods group" of four members was set up, which consisted of members of the task force. Who these are and how their results were used and evaluated remains unclear in the addendum. The guidance documents do not indicate any other measures that could reduce the impact of conflicts of interest.

Explanations to the evaluation criteria

Overall score


Good! (11-18)

Warning! (6-10)

Needs reform! (0-5)


This new edition of the 2017 ESC Guideline has a further increasing proportion of participants with conflicts of interest: While in 2017 4 out of 18 members were free of conflicts of interest, there is no longer a single author without conflicts of interest in this version. In other respects, too, our assessment of 2018 remains the same as for this update: "Heart valve surgery causes high costs, so this guideline is naturally in the sights of heart valve manufacturers - especially since the ESC guidelines are de facto valid throughout Europe and are also adopted in Germany by the German Society of Cardiology.
In addition to transparency, the ESC urgently needs to introduce effective conflict of interest management, otherwise the independence of the guideline will not come close to national guidelines (in particular the German AWMF regulations). The following measures should be considered: targeted recruitment of independent coordinators and authors, assessment of conflicts of interest by an independent body that also proposes consequences for those involved with conflicts of interest, exclusions in the event of serious conflicts of interest (consultancy contracts), practiced and documented abstentions in the event of low or moderate conflicts of interest, public discussion of the draft guideline."

Note: This evaluation was conducted with due care on the basis of the published guideline. Should you still discover an error, please contact us at info@leitlinienwatch.de.