• Hernán Bayona, Mayowa Owolabi, Wuwei Feng, Paul Olowoyo, Joseph Yaria, Rufus Akinyemi, James R Sawers, and Bruce Ovbiagele.
• Department of Neurology, Medical University of South Carolina, Charleston, USA; Department of Neurology, Fundación Santa Fe de Bogotá Hospital, Andes University, Bogota, Colombia.
• J. Neurol. Sci. 2017 Apr 15; 375: 360-366.

Background And PurposeImplementation of contextually appropriate, evidence-based, expert-recommended stroke prevention guideline is particularly important in Low-Income Countries (LMICs), which bear disproportional larger burden of stroke while possessing fewer resources. However, key quality characteristics of guidelines issued in LMICs compared with those in High-Income Countries (HICs) have not been systematically studied. We aimed to compare important features of stroke prevention guidelines issued in these groups.MethodsWe systematically searched PubMed, AJOL, SciELO, and LILACS databases for stroke prevention guidelines published between January 2005 and December 2015 by country. Primary search items included: "Stroke" and "Guidelines". We critically appraised the articles for evidence level, issuance frequency, translatability to clinical practice, and ethical considerations. We followed the PRISMA guidelines for the elaboration process.ResultsAmong 36 stroke prevention guidelines published, 22 (61%) met eligibility criteria: 8 from LMICs (36%) and 14 from HICs (64%). LMIC-issued guidelines were less likely to have articulation of recommendations (62% vs. 100%, p=0.03), involve high quality systematic reviews (21% vs. 79%, p=0.006), have a good dissemination channels (12% vs 71%, p=0.02) and have an external reviewer (12% vs 57%, p=0.07). The patient views and preferences were the most significant stakeholder considerations in HIC (57%, p=0.01) compared with LMICs. The most frequent evidence grading system was American Heart Association (AHA) used in 22% of the guidelines. The Class I/III and Level (A) recommendations were homogenous among LMICs.ConclusionsThe quality and quantity of stroke prevention guidelines in LMICs are less than those of HICs and need to be significantly improved upon.Copyright © 2017 Elsevier B.V. All rights reserved.

20 keywords...

hide…