When does it make sense to use the GRADE approach in a systematic review? Some journals demand it but if the included studies are heterogenous, is it even possible?
You are right, sometimes it seems that it is something that is done to fulfill a requirement rather than something else. In favor, I would say that it provides a vision of how the author evaluates the included studies
One of the aims of the GRADE Working Group was to reduce unnecessary confusion arising from multiple systems for grading evidence and recommendations, there are some criteria that should be met when stating that the GRADE approach was used:
The certainty in the evidence/quality of evidence.
Explicit consideration should be given to each of the GRADE domains for assessing the certainty in the evidence.
The overall certainty in the evidence should be assessed for each important outcome using four or three categories (such as high, moderate, low and/or very low).
Evidence summaries and evidence to decision criteria should be used as the basis for judgments about the certainty in the evidence and the strength of recommendations.
Explicit consideration should be given to each of the GRADE criteria for determining the direction and strength of a recommendation or decision.
The strength of recommendations should be assessed using two categories (for or against an option) and definitions for each category such as strong and weak/conditional. Remember all the definitions should be defined consistently with the definitions used by the GRADE Working Group.
GRADE approach graded the quality of your finally drawn evidence from meta-analysis, it will help the readers about the strength of evidence. It helps to determine whether drawn evidence are conclusive (sufficient for clinical practice) or suggestive (need some more studies). I recommend to use GRADE of any meta-analysis. Even in the presence of heterogeneity, evidence should be graded because heterogeneity is also one of the component of grading.