The Emulation and Adaptation of a Global Model of Clinical Practice Guidelines on Chronic Heart Failure in BRICS Countries: A Comparative Study

Abstract

Whilst knowledge about diseases is universal, access to health care is not equally distributed. During the last decade, the countries of BRICS (Brazil, Russia, India, China, South Africa) have become important actors on the global health scene, pushing for universal, affordable, and more equal access to health care. Although non-communicable diseases place a significant burden on all populations and health systems, low- and middle-income countries (LMIC), such as BRICS, have been affected particularly hard. Approximately 80 percent of worldwide deaths from non-communicable diseases occur in LMIC. We examined if guidelines concerning chronic heart failure from BRICS countries are influenced by global scripts and if these guidelines have converged or diverged in an inter-state context. Our analysis shows that guidelines on heart failure published in BRICS predominantly rely on models initially formulated by European or American cardiological organisations. Guidelines from BRICS deviate from these models to some extent, in particular with regard to specific epidemiological conditions. Except for the Indian guideline, they do not, however, extensively engage with BRICS-specific aspects of costs, access to and affordability of health care services. We interpret these results through the lens of sociological theories on globalisation. Consistent with neoinstitutionalism, recommendations for clinical practice guidelines have spread in BRICS countries in a rather isomorphic fashion. Notwithstanding, some local medical traditions have also been included into these guidelines through localised adaptation and variation.

The Globalisation of Cardiology and Cardiovascular Diseases in the World–Society—A Case Study with a Special Focus on Heart Failure

“…Therefore, NPs have also made their way into clinical practice guidelines for the diagnosis and treatment of heart failure. As we previously demonstrated [34], recommendations with regard to the use of NPs as diagnostic tools have become exceedingly similar across a number of heart failure guidelines from a range of different countries.…”

“…This trend has continued over the last three decades, and ever more national cardiac organisations created such working groups and special interest groups. Moreover, two important organisations with a scope beyond national borders were created in the 1990s: the ESC's Heart Failure Association and the Heart Failure Society of America [34].…”

“…Interestingly, four of these journals are also associated with, or published on behalf of, members of an informal coalition of organisations that we dubbed the 'transatlantic five' of heart failure elsewhere. We argued that the worldwide knowledge production in regard to heart failure is largely structured in terms of a logic of epistemic centres and peripheries, with the transatlantic five (ESC, HFA, ACC, AHA, and HFSA) being the dominating actors of the centre [34]. Taken in its own right, the fact that some new journals have been recently introduced to the cardiological community-though in part, they even rank high according to citation impact-is but one indication for the growing significance of heart failure as a genuine subspeciality.…”

“…Among a total of 1,603,129 documents in this research field, the guidelines on heart failure published by the European Society of Cardiology in 2016 [40], and the guidelines published by the American Heart Association/American College of Cardiology/Heart Failure Society of America in 2013 [41] rank 15th and 25th, respectively. Moreover, our previous analysis [34] demonstrated that there has been a trend in the global cardiological community to develop clinical practice guidelines for the diagnosis and treatment of heart failure since the 1990s, and that this trend has spread to many countries and cardiac organisations around the world.…”

Re-thinking society: How can sociological theories help us understand global and cross-border social contexts?

“…The languages of English, Cantonese and Mandarin, all of which Dr Jia uses on a regular basis, constitute publics overlapping with several countries. And her daily practice is structured by institutional frameworks, such as health policy, that converge with global standards, even though they may appear to be national (Liu et al, 2020; Meyer et al, 1997; Sassen, 2007).…”