Applicability of ischemic heart disease clinical practice guidelines in low- and middle-income countries
Giuseppe Ambrosio1, Luis Henrique Wolff Gowdak2, Richard B Weiskopf3
1National Institute for Cardiovascular Research - INRC, Bologna, Italy.
Insights
Ischemic heart disease (IHD) guidelines are less applicable in low- and middle-income countries (LMIC) due to cost and relevance. Future guidelines need LMIC input and cost considerations for global health equity.
Area of Science:
- Cardiology
- Global Health
- Health Policy
Background:
- Ischemic heart disease (IHD) poses a significant global health challenge.
- Current clinical practice guidelines for IHD are often developed in high-income countries (HIC), potentially overlooking implementation barriers in low- and middle-income countries (LMIC).
Purpose of the Study:
- To assess clinicians' use of IHD guidelines.
- To identify perceived deficiencies and implementation barriers of IHD guidelines.
- To compare guideline applicability between HIC and LMIC settings.
Main Methods:
- An international, internet-based survey of physicians treating IHD patients.
- Data collected on demographics, experience, and views on IHD guideline applicability.
- Survey conducted from July 26, 2025, to November 15, 2025.
Main Results:
- 587 clinicians from 97 countries responded.
- Only 51.8% found IHD guidelines applicable, with lower rates in LMIC (48.8%) vs. HIC (67.3%).
- Major barriers included guideline relevance to HIC (72%) and cost, particularly for LMIC (61.7%).
Conclusions:
- Current IHD guidelines inadequately address the needs of clinicians and patients in LMIC.
- Future guidelines should include LMIC-specific recommendations and consider cost reimbursement.
- Digital formats and LMIC co-authorship were desired for future guidelines.
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.
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