International Circulation:  In real world clinical practice， which guideline recommendation is most difficult to adhere for patients and which one is most difficult for physicians?
《国际循环》：在现实的临床实践中，对患者而言，最难遵守的指南推荐是什么？对医生来说，最难的又是什么？

Mariell Jessup:  It is very difficult for patients to take a lot of drugs.  Now， the optimal treatment for heart failure requires a patient to take 3 or 4 drugs plus， if they have any other diseases like diabetes or abnormal lipids.  Patients don’t like to take a lot of drugs or to follow a low-salt diet because it is difficult.  For physicians it is very hard to have to explain to so many patients over and over again how the drugs work， why they should take them， and what is important.  It is a complicated regimen， it is not fun for the patients and it takes a lot of time for the clinicians.
Mariell Jessup: 对患者来说，服用很多药物很难。现在心衰的最理想的治疗要求患者服用三至四种药物。如果他们有任何其他疾病，如糖尿病或者血脂异常，他们甚至不得不服用更多药物。患者同样也不喜欢遵守低盐饮食，因为这也很难。对医生来说，难的是一遍遍地跟这么多患者解释药物如何发挥作用，为什么他们要服用这些药物和什么是比较重要的。这些复杂的药物组合对患者来说很无趣，也花费医生大量的时间。