Barriers and facilitators for the Uptake of the National INOCA Recommendation Among Dutch Cardiologists: A survey study

Background In 2020, the Dutch Society for Cardiologists (NVVC) published a national recommendation for diagnostics and treatment of Ischaemia with Non-Obstructive Coronary Arteries (INOCA), a historically underrecognized condition. In this study we identify determinants of implementation of the NVVC INOCA recommendation through a national survey among Dutch cardiologists. Methods We performed a cross-sectional, nationwide online survey among Dutch cardiologists, incorporating attitudinal statements derived from prior qualitative research and the Measurement Instrument for Determinants of Innovation (MIDI) questionnaire. Descriptive analyses were used to identify facilitators and barriers to implementation. Multiple regression analyses examined associations between attitudinal factors and familiarity with the recommendation. Results A total of 134 cardiologists participated in this study with 78 (58%) completing the long version of the questionnaire and 56 (42%) the short version. Facilitators for implementation were predominantly user-related, driven by positive outcome expectations, perceptions of professional responsibility, and perceived communicative capabilities. In contrast, key barriers were primarily organizational, including the absence of institutional policies, implementation coordination, and performance feedback. Familiarity with the recommendation was independently associated with perceived improvements in INOCA-related knowledge, confidence in communicating under clinical uncertainty, and gender. Conclusions Uptake of the NVVC INOCA recommendation among Dutch cardiologists is largely motivated by individual professional commitment and positive outcome expectations but is constrained by limited organizational support. Strengthening institutional implementation structures and reinforcing professional communicative capabilities may help translate high individual motivation into consistent peer-dissemination and recommendation-concordant INOCA care.