DefinePK

Abstract

According to Alba Eban, consensus means that many people collectively agree on something that no one individually believes [1]. Evidence-based medicine (EBM), as defined by Sackett, involves the conscious, judicious, and explicit use of the best available evidence to make decisions regarding patient care [2]. Since the 1990s, the rise of the "guidelines culture"—a result of EBM—has significantly influenced the activities of American and European scientific societies [3]. EBM has been instrumental in determining the best care practices for patients. With the evolution of this culture, randomized controlled trials, expert involvement, and contributions from various medical societies have shaped the development of clinical guidelines.
Between 1984 and 2008, only 11% of cardiovascular guidelines had a Level A evidence base, whereas 48% relied on Level C recommendations [4]. These guidelines have faced criticism, particularly regarding the involvement of pharmaceutical and medical device companies, which may prioritize economic interests over patient welfare by promoting expensive treatments or focusing on rare diseases. Economic considerations have also played a role in the introduction of guidelines, aiming to reduce healthcare costs. Additionally, within scientific societies, some authors may represent the interests of specific lobbies rather than reaching a truly unanimous consensus.
Despite these concerns, guidelines for conditions such as heart failure, atrial fibrillation, and acute coronary syndrome have been associated with reduced mortality and morbidity due to improved therapeutic measures [5].
An important issue is the medicolegal protection offered by adherence to guidelines. The Balduzzi Law (189/2012) states that healthcare professionals following guidelines set by the scientific community could still face criminal charges for minor negligence. The Gelli Law (24/2017) later modified this, stating that guidelines should be interpreted in the context of individual cases, and that adherence to them does not automatically rule out malpractice [3].
Work on cardiac guidelines in Pakistan and India remains limited. In Pakistan, interventional cardiology guidelines were published in 2017, involving input from government officials. These guidelines aim to facilitate scientific data collection and provide legal protection for physicians [6]. In India, clinical practice guidelines (CPGs) for cardiovascular diseases are generally of low to moderate quality. It has been suggested that improvements could be made through better governance structures and the establishment of principles and standards for reporting and dissemination [7].
Considerations for Developing Local Guidelines
When formulating cardiovascular guidelines in this region, the following factors should be taken into account:

Integration of International Guidelines: Established international guidelines should be carefully adapted by local experts, considering factors such as healthcare costs, practice diversity, and the complexity of evolving treatment options [8].
Comprehensive Scope: Guidelines should encompass not only therapeutic decisions but also diagnostic workups.
Medicolegal Protection: Well-developed guidelines will help cardiologists defend themselves in cases of malpractice allegations.

There is an urgent need to mandate documentation of cardiac disease outcomes, treatment protocols, and registries in all hospitals across the country. Cardiac researchers should systematically collect and analyze data to develop locally relevant guidelines tailored to Pakistan’s healthcare landscape.
AUTHORS' CONTRIBUTION
KAH: Concept and design, data acquisition, interpretation, drafting, final approval, and agree to be accountable for all aspects of the work.
Acknowledgment: None.
Funding: No specific grant for this research from any public, commercial, or not-for-profit funding agency
References

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