Cardiologists’ perspectives on pharmacogenomics implementation in a hybrid health system: A qualitative study from the United Arab Emirates

Background: Pharmacogenomics (PGx) can optimise cardiovascular therapy, yet routine integration in cardiology remains limited. In the United Arab Emirates, a hybrid public–private health system, the real-world PGx use is still emerging. However, there is limited understanding of how cardiologists perceive and navigate PGx implementation within such complex health system contexts. Objective: To examine cardiologists’ perspectives on the feasibility, barriers, and facilitators of implementing PGx using the Consolidated Framework for Implementation Research (CFIR). Methods: A qualitative study using an abductive analytical approach was conducted through semi-structured interviews with 15 cardiologists from public and private institutions. Participants were recruited via purposive, convenience, and snowball sampling. Interviews were transcribed verbatim and thematically analysed in NVivo. The CFIR guided the analysis across intervention characteristics, outer setting, inner setting, individual characteristics, and process. Results: Clinicians expressed strong conceptual support for PGx, especially in higher-risk scenarios, but reported limited hands-on exposure and confidence. Barriers included perceived test complexity, cost, and lack of reimbursement; insufficient laboratory capacity and EHR integration; unclear workflows and role ownership; and turnaround times misaligned with acute care. Outer-setting constraints (ambiguous policy signals and payer criteria) and inner-setting variability (resources, leadership engagement, and communication pathways) further limited uptake. Reported facilitators included multidisciplinary service models (with input from pharmacists and genetics), targeted case-based training, initial deployment in non-acute contexts, and the structured capture of results with EHR-embedded clinical decision support. Conclusions: PGx implementation in cardiology within the UAE is shaped by structural, organisational, and workforce-level gaps. Addressing these through targeted clinical guidance, improved training, stronger reimbursement mechanisms, enhanced laboratory capacity, and integrated digital decision support may enable more equitable and scalable adoption. These findings provide actionable insights for health systems seeking to operationalise PGx within diverse or hybrid healthcare contexts.