Financial relationships with industry among guideline authors for the management of acute ischemic stroke

Am J Emerg Med. 2019 May;37(5):921-923. doi: 10.1016/j.ajem.2019.01.037. Epub 2019 Jan 24.


Objective: To characterize the prevalence of industry relationships among authors of acute ischemic stroke (AIS) guidelines and its association with graded evidence.

Methods: A cross-sectional study of five policy papers on AIS published by the American Heart Association (AHA)/American Stroke Association (ASA), American Academy of Emergency Physicians (AAEM), and American College of Emergency Physicians (ACEP). Financial conflicts of interest (FCOI) data were obtained using the Open Payments Database for the years 2013 through 2017. A search of publicly available information was done to determine post-guideline employment. We characterized the prevalence of FCOI, as well as employment with industry engaged in thrombolysis or neurointerventional treatment of AIS after guideline publication.

Results: 76 unique authors were identified in 5 policy statements. The prevalence of FCOI among authors of AAEM, ACEP, and AHA/ASA guidelines was 0%, 0%, and 35%, respectively. Post-publication increase in FCOI was 0% for authors of the AAEM and ACEP guidelines, and a 300% increase for authors of the 2013 AHA/ASA guidelines with data unavailable to assess post-publication FCOI for authors of the 2018 AHA/ASA guidelines. 2 authors were found to engage in new industry employment following recommendation publication. Finally, 9% (n = 3) authors of the 2013/2018 AHA/ASA guidelines were employees of the Genentech Speakers Bureau.

Conclusions: Our results suggest an association between current Graded Evidence and FCOI of major academic societies for the management of AIS. Due to the bias inherent to such conflicts, future recommendation groups should take steps to insulate against FCOI both during and following guideline publication.

Keywords: Conflict of interest; Stroke; tPA.

MeSH terms

  • American Heart Association
  • Authorship*
  • Brain Ischemia / therapy*
  • Conflict of Interest*
  • Cross-Sectional Studies
  • Drug Industry*
  • Emergency Medicine
  • Fibrinolytic Agents
  • Humans
  • Practice Guidelines as Topic*
  • Societies, Medical
  • Stroke / therapy*
  • Thrombolytic Therapy
  • United States


  • Fibrinolytic Agents