Implementation of guideline-directed medical treatment for ischemic heart disease management: A knowledge, attitude and practice based cross-sectional survey

Umm-e- Kalsoom, Amjad Khan, Syed Sikandar Shah, Ayesha Iqbal, Tahir Mehmood, Syed Mansoor Ahmed, Noshed Khan, Yu Fang

Abstract

Guideline-Directed Medical Therapy (GDMT) is central to managing ischemic heart disease (IHD), yet its implementation remains suboptimal in low- and middle-income countries (LMICs), including Pakistan.

Introduction

Ischemic heart disease (IHD) is the most common cause of deaths among cardiovascular diseases (CVDs) and a significant global health risk [1,2]. Its prevalence is rapidly increasing, with a predicted increase to 1,845 per 100,000 by 2030 [3]. Guidelines-directed medical treatment (GDMT) provides a comprehensive strategy for managing IHD.

Methods

This study employed a cross-sectional survey design conducted from July 5 to September 9, 2024 to assess the KAP of HCPs including cardiologists and clinical pharmacists regarding GDMT implementation. The survey was carried out at a single specialized cardiology center the Punjab Institute of Cardiology (PIC) in Lahore, Pakistan, a tertiary-care hospital dedicated to cardiac patients.

Results

A total of 259 HCPs were invited to participate in the study. Of these, 117 were excluded: 51 did not meet the inclusion criteria, and 45 declined to participate. The remaining 82 participants completed the questionnaire. After excluding 6 incomplete responses, a total of 76 complete responses were included in the final analysis.

Discussion

The management of IHD is a complex process that requires a multidisciplinary approach to optimize patient outcomes [6]. Clinical pharmacists play a crucial role alongside cardiologists as a healthcare team in implementing GDMT for individuals with IHD [33].

Conclusion

This KAP survey found that cardiologists in Lahore, Pakistan, demonstrated higher knowledge and more favorable attitudes toward GDMT for IHD than clinical pharmacists, although both groups reported similar levels of guideline-based practice.

Citation: Kalsoom U-e-, Khan A, Shah SS, Iqbal A, Mehmood T, Ahmed SM, et al. (2026) Implementation of guideline-directed medical treatment for ischemic heart disease management: A knowledge, attitude and practice based cross-sectional survey. PLoS One 21(2): e0338634. https://doi.org/10.1371/journal.pone.0338634

Editor: Mohammed Abutaleb, Jazan Health Cluster, SAUDI ARABIA

Received: April 7, 2025; Accepted: November 25, 2025; Published: February 4, 2026

Copyright: © 2026 Kalsoom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.