AimsClinical 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).Methods and resultsAn 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).ConclusionThis 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.

中文翻译：

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心力衰竭临床实践指南在低收入和中等收入国家的适用性


目标临床实践指南通常由高收入国家 （HIC） 的专业协会编写，对其他环境中实施障碍的预期有限。我们以心力衰竭 （heart failure， HF） 指南为范例来研究这一问题，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 （low‐and middle-income countries， LMIC） 的适用性的看法。方法和结果2023 年 10 月 5 日至 11 月 27 日通过电子邮件对转化医学学院数据库中治疗 HF 患者的医生进行了在线调查，询问参与者的人口统计信息、经验和对与其实践相关的 HF 指南的看法。在 2622 名参与的临床医生中，1592 人部分完成，另有 1030 人完全完成调查。参与者来自 138 个国家;668 人在 HIC 执业，1954 人在 LMIC 执业。来自 LMIC 的受访者认为 HF 指南在他们国家的适用性低于 HIC 的指南 （p = 0.0002）。在所有受访者中，75.3% 的人表示 HF 指南在一定程度上或大部分适用于 HIC。来自中低收入国家（而非 HIC）的受访者表明，最大的实施障碍是指南是针对 HIC 的 （51.3% vs. 43.1%;p = 0.0387）。与 HIC 的受访者相比，LMIC 的受访者表示在大多数情况下，用于照顾患者的资源在一定程度上或大部分受到限制的比例显著更高 （41.6% vs. 32.5%，p = 0.0068）。结论这项调查考察了人们普遍持有的 HF 指南广泛适用于世界所有地区的观点，得出的结论是这种看法是不正确的。 LMIC 的临床医生认为，不考虑当地资源限制是指南实施的最大障碍。关于 HF 指南的结果也可能对其他指南和由此产生的患者结局产生影响。