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BMJ Glob Health. 2016 Oct 5;1(3). pii: e000105. eCollection 2016.

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism.

Author information

Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria; World Federation for Neurorehabilitation-Blossom Specialist Medical Center, Ibadan, Nigeria.
Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Department of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria.
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.


Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.

Conflict of interest statement

The authors are members of the Global Alliance for Chronic Diseases—COntrol UNique to Cardiovascular diseases In LMICs—(GACD-COUNCIL) initiative. GACD is the first alliance of the world’s biggest public research funding agencies, which currently is funding 15 hypertension and 16 diabetes implementation science projects in LMICs. MO is the pioneer chair of the H3Africa CVD research consortium, the largest in Africa with projected sample size of >55 000 participants. BO is a pre-eminent stroke physician with expertise in guideline development. JM has expertise in implementation science for CVDs in LMICs. The ideas presented here respond to the challenges of combatting CVDs in LMICs. MO and BO are supported by U01 NS079179 and U54 HG007479 from the National Institute of Health and the GACD.

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