Key result
A national survey of 305 cardiologists in Pakistan revealed significant departures from recommended heart failure management, with only 0% to 20% of respondents making recommendations that completely matched ESC guidelines across three clinical scenarios.
Cross-Sectional (n=305)
Yes
Despite high self-reported adherence to heart failure guidelines, Pakistani cardiologists demonstrated significant departures from recommended management in clinical scenarios, citing patient compliance and cost as major barriers.
Low perceived ESC HF guideline relevance despite high awareness; leaves open need for localized implementation studies before practice change.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
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Shoukat et al. (2011) conducted a cross-sectional in Chronic heart failure (management practices) (n=305). ESC guidelines for chronic heart failure was evaluated on Proportion of respondents whose recommendations completely matched ESC guidelines for three patient scenarios. A national survey of 305 cardiologists in Pakistan revealed significant departures from recommended heart failure management, with only 0% to 20% of respondents making recommendations that completely matched ESC guidelines across three clinical scenarios.
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