Keywords: primary care; ESC guidelines; cardiovascular disease; implementation; multimorbidity

Aim:

To assess real-world use of selected European Society of Cardiology (ESC) cardiovascular guidelines in primary care and identify barriers and practical needs for their effective implementation.

Method:

A brief anonymous cross-sectional survey was conducted among practicing general practitioners (GPs) and GP trainees in the Plovdiv region, Bulgaria. The questionnaire focused on five ESC guideline domains and assessed frequency of use, confidence in application, perceived barriers, and preferred implementation tools.

Results:

A total of 62 respondents completed the survey (71% GPs, 29% GP trainees; mean practice experience 9.4 ± 6.8 years). Awareness of ESC cardiovascular guidelines was high (95%). Routine use varied by condition: hypertension (72%), dyslipidaemia (68%), atrial fibrillation (54%), heart failure (46%), and stable coronary syndrome (41%). The most frequently reported barriers were limited consultation time (81%), complexity of recommendations (59%), challenges related to multimorbidity and polypharmacy (57%), and difficulty prioritising guidance across multiple conditions (52%). Overall, 64% of respondents reported moderate-to-low confidence when applying more than one ESC guideline simultaneously, increasing to 74% in elderly patients with multimorbidity. Preferred support tools included concise step-by-step algorithms (83%), one-page summaries (76%), referral “red flag” checklists (71%), and digital point-of-care tools integrated into daily workflow (78%). Only 16% considered full guideline documents practical for routine primary care use.

Conclusions:

Moving ESC cardiovascular guidelines from paper to the driver’s seat of primary care requires adaptation to real-world practice. Concise, multimorbidity-oriented and digitally accessible formats may substantially improve guideline implementation and support high-quality cardiovascular care in everyday primary care settings.