Bayona Hernán, Owolabi Mayowa, Feng Wuwei, Olowoyo Paul, Yaria Joseph, Akinyemi Rufus, Sawers James R, Ovbiagele Bruce
Department of Neurology, Medical University of South Carolina, Charleston, USA; Department of Neurology, Fundación Santa Fe de Bogotá Hospital, Andes University, Bogota, Colombia.
Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria.
J Neurol Sci. 2017 Apr 15;375:360-366. doi: 10.1016/j.jns.2017.02.040. Epub 2017 Feb 20.
Implementation of contextually appropriate, evidence-based, expert-recommended stroke prevention guideline is particularly important in Low-Income Countries (LMICs), which bear disproportional larger burden of stroke while possessing fewer resources. However, key quality characteristics of guidelines issued in LMICs compared with those in High-Income Countries (HICs) have not been systematically studied. We aimed to compare important features of stroke prevention guidelines issued in these groups.
We systematically searched PubMed, AJOL, SciELO, and LILACS databases for stroke prevention guidelines published between January 2005 and December 2015 by country. Primary search items included: "Stroke" and "Guidelines". We critically appraised the articles for evidence level, issuance frequency, translatability to clinical practice, and ethical considerations. We followed the PRISMA guidelines for the elaboration process.
Among 36 stroke prevention guidelines published, 22 (61%) met eligibility criteria: 8 from LMICs (36%) and 14 from HICs (64%). LMIC-issued guidelines were less likely to have articulation of recommendations (62% vs. 100%, p=0.03), involve high quality systematic reviews (21% vs. 79%, p=0.006), have a good dissemination channels (12% vs 71%, p=0.02) and have an external reviewer (12% vs 57%, p=0.07). The patient views and preferences were the most significant stakeholder considerations in HIC (57%, p=0.01) compared with LMICs. The most frequent evidence grading system was American Heart Association (AHA) used in 22% of the guidelines. The Class I/III and Level (A) recommendations were homogenous among LMICs.
The quality and quantity of stroke prevention guidelines in LMICs are less than those of HICs and need to be significantly improved upon.
在低收入国家（LMICs）实施因地制宜、基于证据且由专家推荐的卒中预防指南尤为重要，这些国家卒中负担 disproportionately 更大，而资源却更少。然而，与高收入国家（HICs）相比，低收入国家发布的指南的关键质量特征尚未得到系统研究。我们旨在比较这些群体发布的卒中预防指南的重要特征。
我们系统检索了 PubMed、AJOL、SciELO 和 LILACS 数据库，以查找 2005 年 1 月至 2015 年 12 月期间各国发布的卒中预防指南。主要检索词包括：“卒中”和“指南”。我们对文章的证据水平、发布频率、临床实践可翻译性和伦理考量进行了严格评估。我们遵循 PRISMA 指南进行阐述过程。
在发布的 36 项卒中预防指南中，22 项（61%）符合纳入标准：8 项来自低收入国家（36%），14 项来自高收入国家（64%）。低收入国家发布的指南不太可能有推荐意见的阐述（62%对 100%，p = 0.03），涉及高质量的系统评价（21%对 79%，p = 0.006），有良好的传播渠道（12%对 71%，p = 0.02）以及有外部审稿人（12%对 57%，p = 0.07）。与低收入国家相比，患者观点和偏好是高收入国家最显著的利益相关者考量因素（57%，p = 0.01）。最常用的证据分级系统是美国心脏协会（AHA），在 22%的指南中使用。I/III 类和（A）级推荐在低收入国家中是同质的。
低收入国家卒中预防指南的质量和数量低于高收入国家，需要大幅改进。
