Introduction

Research on clinical practice guidelines as a determinant of the diffusion of medical technology remains sparse. We aim to evaluate the impact of guidelines on the awareness of medical technology, as a proxy of its use, with the example of cardiac resynchronization therapy (CRT) in the United Kingdom (UK).

Methods

We measured clinician awareness based on Google searches performed for CRT that corresponded with actual CRT implant numbers provided by the European Heart Rhythm Association (EHRA). We identified the guideline recommendations published by the National Institute of Health and Care Excellence (NICE) within the UK, the European Society of Cardiology (ESC) at the European level, and the American College of Cardiology Foundation/American Heart Association in the United States (US). We specified a dynamic moving average model, with Google searches as the dependent variable and guideline changes as the independent variables.

Results

One guideline change published by NICE in 2007 and two changes released by the US guidelines in 2005 and 2012 were significantly correlated with the Google searches (p = 0.08, p = 0.02, and p = 0.02, respectively). Guideline changes by the ESC had no significant impact. Changes recommending CRT in place of a conventional pacemaker, in patients with atrial fibrillation, and restricting CRT due to contraindication, remained universally uninfluential.

Conclusion

The factors associated with a lack of awareness (as a proxy for technology diffusion) in our case study were: a lack of strong clinical evidence that resulted in the moderate strength of a recommendation, a lack of recognition of any externally published recommendation by NICE, and the frequent release of guidelines with minor changes targeting small patient groups. At least in our case, in the absence of NICE guidelines, the US guidelines received more attention than their non-UK European counterparts, even if the former were released after the latter.

中文翻译：

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指南对医疗技术传播的影响：英国心脏再同步治疗的案例研究

介绍

将临床实践指南作为医疗技术传播的决定因素的研究仍然很少。我们的目标是评估指南对医疗技术意识的影响，作为其使用的代理，以英国（UK）的心脏再同步治疗 (CRT) 为例。

方法

我们根据对 CRT 执行的 Google 搜索测量了临床医生的意识，这些 CRT 搜索与欧洲心律协会 (EHRA) 提供的实际 CRT 植入物编号相对应。我们确定了英国国家健康与护理卓越研究所 (NICE)、欧洲心脏病学会 (ESC) 和美国心脏病学会基金会/美国心脏协会发布的指南建议（我们）。我们指定了一个动态移动平均模型，以谷歌搜索为因变量，指南变化为自变量。

结果

2007 年 NICE 发布的一项指南变更和 2005 年和 2012 年美国指南发布的两项变更与 Google 搜索显着相关（分别为p  = 0.08、p  = 0.02 和p  = 0.02）。ESC 的指南更改没有显着影响。在房颤患者中推荐 CRT 代替传统起搏器的变化，以及由于禁忌症而限制 CRT，仍然普遍没有影响。

结论

在我们的案例研究中，与缺乏意识（作为技术传播的代理）相关的因素是：缺乏导致推荐强度中等的强有力的临床证据，缺乏对 NICE 任何外部发布的推荐的认可，并且经常发布针对小患者群体的指南，稍作改动。至少在我们的案例中，在没有 NICE 指南的情况下，美国的指南比非英国的欧洲同行受到更多的关注，即使前者是在后者之后发布的。