Applicability of ischemic heart disease clinical practice guidelines in low- and middle-income countries.

BACKGROUND: Ischemic heart disease (IHD) presents a growing global health burden across diverse geographic and socioeconomic settings. Clinical practice guidelines are typically developed by professional societies in high-income countries, often with limited consideration of implementation barriers in other healthcare settings. We sought to understand clinicians' use of IHD guidelines in their practice, perceived deficiencies, implementation barriers, and differences between doctors practicing in high-income countries (HIC) or in low-/middle-income countries (LMIC). METHODS: An internet-based, international survey of physicians treating patients with IHD, (July 26, 2025-November 15, 2025), inquiring about participants' demographics, experience, and views of IHD guidelines as related to their practice. RESULTS: Responses were provided by 587 clinicians from 97 countries. Approximately half (51.8%) considered the IHD guidelines as mostly or fully applicable in their country, a view more preponderant in HIC (67.3%) than in LMIC (48.8%; p = 0.0125). Most (63.2%) thought IHD guidelines were highly applicable in HIC, but only 9.0% deemed the same for LMIC. The greatest barriers to guideline implementation were their being mostly relevant for HIC (72%), and cost, with the latter selected more frequently by the LMIC than the HIC group (61.7% v 20.4%; p < 0.00001). Desires for future guidelines included availability in digital format, and inclusion of co-authors from LMIC. CONCLUSIONS: Survey respondents indicated that current IHD guidelines do not address the needs of clinicians and patients in LMIC as effectively as they do for those in HIC. Respondents advocated for future guidelines to have specific recommendations for differing socio-economic environments, and consideration of cost reimbursement.

Duke Scholars

Author Marat Fudim Medicine, Cardiology