Zieroth Shelley, Giraldo Clara Inés Saldarriaga, Pinto Fausto, Anker Stefan D, Abraham William T, Atherton John J, Butler Javed, Chopra Vijay, Coats Andrew J S, Dean Veronica, Filippatos Gerasimos, Zamorano Jose Luis, Zhang Yuhui, Weiskopf Richard B, Colardelle Yann
Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Cardiology Department, Pontifical Bolivarian University and University of Antioquia, Medellín, Colombia.
Eur J Heart Fail. 2025 Mar;27(3):435-441. doi: 10.1002/ejhf.3485. Epub 2024 Oct 25.
Clinical practice guidelines are commonly written by professional societies in high-income countries (HIC) with limited anticipation of implementation obstacles in other environments. We used heart failure (HF) guidelines as a paradigm to examine this concern, by conducting a survey to understand clinicians' ability to implement HF guidelines and their perceptions of the current HF guideline applicability in low- and middle-income countries (LMIC).
An online survey of physicians in the database of the Translational Medicine Academy who treat HF patients was offered by email from 5 October to 27 November 2023, inquiring of participants' demographic information, experience, and views of HF guidelines as related to their practice. Of 2622 participating clinicians, 1592 partially completed, and an additional 1030 fully completed the survey. Participants were from 138 countries; 668 practiced in HIC, and 1954 in LMIC. Those from LMIC regarded HF guidelines to be less applicable in their country than did those from HIC (p = 0.0002). Of all those responding, 75.3% indicated that it was somewhat or mostly true that the HF guidelines were mostly applicable to HIC. Those from LMIC, but not HIC indicated that the greatest implementation obstacle was that the guidelines were for HIC (51.3% vs. 43.1%; p = 0.0387). A significantly higher proportion of respondents from LMIC indicated that resources for caring for their patients were somewhat or mostly limiting in most cases, than did those in HIC (41.6% vs. 32.5%, p = 0.0068).
This survey examined the widely-held thought that HF guidelines are broadly applicable to all regions of the world, concluding that such a perception is incorrect. Clinicians from LMIC view the absence of consideration of local resource limitations as the greatest obstacle for guideline implementation. The results regarding HF guidelines likely also have implications for other guidelines and resultant patient outcomes.
临床实践指南通常由高收入国家（HIC）的专业协会编写，对其他环境中的实施障碍考虑有限。我们以心力衰竭（HF）指南为例来审视这一问题，通过开展一项调查来了解临床医生实施HF指南的能力以及他们对当前HF指南在低收入和中等收入国家（LMIC）适用性的看法。
2023年10月5日至11月27日通过电子邮件对转化医学研究院数据库中治疗HF患者的医生进行了一项在线调查，询问参与者的人口统计学信息、经验以及与其实践相关的HF指南看法。在2622名参与调查的临床医生中，1592人部分完成了调查，另有1030人完全完成了调查。参与者来自138个国家；668人在高收入国家执业，1954人在低收入和中等收入国家执业。来自低收入和中等收入国家的人认为HF指南在其国家的适用性低于来自高收入国家的人（p = 0.0002）。在所有回复者中，75.3%表示HF指南大多适用于高收入国家这一说法在某种程度上或很大程度上是正确的。来自低收入和中等收入国家但非高收入国家的人表示，最大的实施障碍是这些指南是针对高收入国家的（51.3%对43.1%；p = 0.0387）。与高收入国家的受访者相比，来自低收入和中等收入国家的受访者中，有显著更高比例的人表示在大多数情况下，照顾患者的资源在某种程度上或很大程度上是有限的（41.6%对32.5%，p = 0.0068）。
这项调查审视了一种广泛持有的观点，即HF指南广泛适用于世界所有地区，得出的结论是这种看法是不正确的。来自低收入和中等收入国家的临床医生认为未考虑当地资源限制是指南实施的最大障碍。关于HF指南的结果可能也对其他指南及最终的患者结局有影响。
