Guideline adherence for the management of cardiovascular disease in primary care: a scoping review

Worldwide, cardiovascular diseases (CVDs) persist as a leading cause of mortality. Clinical practice guidelines (CPGs) aim to support evidence-based decision-making and improve outcomes in primary care. However, application of these guidelines is often inconsistent, raising concerns about potential unconsidered barriers to implementation.

This review aimed to assess the extent to which CVD-related CPGs are followed in general practice and factors influencing the application.

A structured literature review was conducted in August 2025 in accordance with the PRISMA-ScR guidelines, using MEDLINE (PubMed), Cochrane Library, and Web of Science. The inclusion criteria comprised original studies in English or German that focused on CPG adherence in primary care related to CVDs.

After screening 791 studies, 37 were included. Most of these studies had a cross-sectional design and were conducted in Europe. Reported CPG application varied considerably, ranging from 4% to 100% depending on the disease area and evaluation method. Factors influencing CPG application included time constraints, systemic factors, and limitations within the guidelines themselves. Especially complex cases led to concerns about side effects and to deviations from the guideline.

Despite high awareness, the adherence to cardiovascular guidelines in general practice has a high variance. As patients in primary care are often multimorbid, evidence-based recommendations often need to be tailored to the patient's needs. Guideline enhancement should therefore emphasize practicality, comprehensibility, and the incorporation of general practitioners' viewpoints.