title: Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan.
abstract: 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.
  
  
  CONCLUSIONS
  We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
authors.affiliation: Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA. sana.shoukat@gmail.com
authors.forename: Sana
authors.initials: S
authors.lastname: Shoukat
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Gowani
authors.forename: Ather M
authors.initials: AM
authors.lastname: Taqui
authors.forename: Rameez
authors.initials: R
authors.lastname: Ul Hassan
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Anum I
authors.initials: AI
authors.lastname: Malik
authors.forename: Sajjad A
authors.initials: SA
authors.lastname: Sherjeel
authors.forename: Quratulanne
authors.initials: Q
authors.lastname: Sheheryar
authors.forename: Sajid H
authors.initials: SH
authors.lastname: Dhakam
mesh_terms: D000328:Adult; D002309:Cardiology / Q000592:standards*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010820:Physicians / Q000592:standards*
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