Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA.
BMC Cardiovasc Disord. 2011 Nov 17;11:68. doi: 10.1186/1471-2261-11-68.
The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines.
A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines.
A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation.
We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
本研究旨在评估巴基斯坦心脏病专家对 2005 年欧洲心脏病学会（ESC）心力衰竭指南的认知和态度，并评估遵循指南的障碍。
2009 年 3 月至 7 月，在巴基斯坦 4 个主要城市（卡拉奇、拉合尔、奎达和白沙瓦）对所有执业心脏病专家进行了横断面调查。使用经过验证的半结构化问卷评估 ESC 2005 年心力衰竭指南，从心脏病专家那里获取信息。它包括有关心力衰竭指南的认识和相关性的问题（见附加文件 1）。根据指南，将受访者的管理选择与专家组对三个虚构患者病例的选择进行了比较。还询问了心脏病专家遵守指南的主要障碍。
共接触了 372 名心脏病专家，305 名同意参与（总体响应率为 82.0%）。调查显示，对 CHF 指南的认识非常高；97.4%的人了解任何指南。约 13.8%的人认为 ESC 指南对指导治疗决策相关或非常相关，而 92.8%的人认为 AHA 指南相关。87.2%的受访者认为他们遵守了心力衰竭指南。对于患者病例，建议完全符合指南的受访者比例为 7%（情景 1）、0%（情景 2）和 20%（情景 3）。受访者认为患者依从性（59%）和成本/健康经济学（50%）是指南实施的主要障碍。
我们发现巴基斯坦心脏病专家在推荐的心力衰竭管理指南方面存在重要的自我报告偏离。
