Abstract 12731: Implementation Barriers of Class 1a Heart Failure Guideline Recommendations in Developing Countries

Abstract

Introduction: In April 2022, the American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) released an updated guideline for the management of heart failure (HF). The degree to which these guideline recommendations can be broadly implemented in resource-limited settings, including some developing countries, has not been described. Methods: The 2022 AHA/ACC/HFSA HF guidelines were reviewed and Class 1A recommendations were analyzed for potential implementation barriers in developing countries. For this analysis, Venezuela was used as a case example. Implementation barriers were analyzed on a Likert-type scale from “not a barrier” to “extreme barrier”. Among recommendations with moderate to extreme implementation barriers, potential limiting factors were specified. Results: A total of twenty-two Class 1A HF recommendations were analyzed for potential implementation barriers. Among them, 8 (36%) were classified as “not a barrier”, 3 (14%) as “somewhat of a barrier”, 5 (23%) as “moderate barrier”, and 6 (27%) as “extreme barrier”. Regarding limiting factors, 10 (50%) were related to non-availably of therapeutic drugs/interventions, 4 (20%) involved high incurring costs, and 6 (30%) were related to lack of formal training in HF and/or multidisciplinary specialized care (Figure). Conclusions: There are potential implementation barriers to Class 1A recommendations made in the 2022 AHA/ACC/HFSA HF guidelines in resource limited settings, particularly in certain developing countries where availability and costs of interventions, and lack of formal HF training, represent important limiting factors. Further endeavors should encourage guideline-based recommendations to address resource-limited settings and efforts should be made to maximize implementation around the world.