Standardizing the management of cardiovascular diseases in the primary health care setting of Pakistan

Background: Cardiovascular diseases are increasingly prevalent in Pakistan. The establishment of clinical practice guidelines (CPGs) and primary-care referral pathways can help primary care physicians (PCPs) play a greater role in the management of patients to optimize the delivery of care. In this study, we aimed to develop CPGs and primary-care referral pathways that are specific to Pakistan’s primary-care setting in the context of ischemic heart disease (IHD) and congestive heart failure (CHF). Methods: The GRADE-ADOLOPMENT approach was utilized, and source guidelines were selected based on relevance, scope, and rigor. Recommendations were scrutinized for adoption, adaptation, or exclusion based on local feasibility and applicability. A structured review process involved internal and external expert reviewers to ensure credibility and relevance. Additionally, contextual clinical referral pathways were crafted to guide PCPs in patient management and specialist referrals. Results: Through the GRADE-ADOLOPMENT process, contextualized CPGs for managing stable IHD and CHF in Pakistan’s primary care setting were successfully developed. A total of 72 recommendations were excluded from source guidelines due to various reasons, while the remaining recommendations were deemed applicable and adopted into the local CPGs. Clinical referral pathways were drafted to facilitate efficient and resource-saving referrals by PCPs, ensuring appropriate care for patients requiring specialist attention. 4 recommendations were added to the referral pathways to cover gaps in care provision. Conclusions: This guideline has thus been tailored to suit the local context and support physicians with evidence-based recommendations that are feasible for implementation in the Pakistani setting.