New one-stop guideline for cardiovascular health in Canada

A new one-stop guideline takes a 360-degree approach to managing heart disease in Canadian patients, with 83 recommendations in one easy-to-use reference. The guideline is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220138.

"Clinicians are rightly concerned that there are too many guidelines with too many individual recommendations to be practical and useful for daily use, particularly in primary care. Typical patients with multiple illnesses require the access to many guidelines at the same time, and some recommendations are not harmonized and often seem contradictory," says Dr. Peter Liu, chief scientific officer at the University of Ottawa Heart Institute, and a senior author of the latest C-CHANGE guideline. "We hope this fourth update to the very popular C-CHANGE guideline will further meet the needs of health professionals and patients, to prevent and treat cardiovascular conditions and associated brain health with a simple harmonized approach."

An update to a 2018 publication, the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) resource includes 48 new or revised recommendations out of the 83, from 11 cardiovascular-focused guideline groups across the country.

Aimed at primary care and other health care providers, the C-CHANGE guideline contains actionable recommendations for Canadian adults with or at risk of cardiovascular disease, including

• people with obesity, diabetes or hypertension;
• people with dyslipidemia, atherosclerotic vascular disease or heart failure; and
• people with atrial fibrillation, stroke or dementia.

It also includes health behaviour recommendations for all Canadians to address risk factors for these conditions, such as dietary, smoking and physical activity considerations.

"C-CHANGE is all about singing from the same song sheet," says Dr. Sheldon Tobe, co-chair of C-CHANGE and nephrologist at Sunnybrook Health Sciences Centre. "Our goal is to help health care providers understand the evidence for best practices, and if they can follow the guidelines, the health of the Canadian population could substantially improve."

What's different from before?

More than 50% of the guideline contains new or revised recommendations from the previous 2018 version. This guideline is also more comprehensive and holistic in caring for patients with multimorbidity.

Partnership has expanded to include Health Canada's Dietary Guideline, the Canadian Consensus Conference on Diagnosis and Treatment of Dementia, and the Canadian Cardiovascular Society/Canadian Heart Rhythm Society guideline for the management of atrial fibrillation. It also includes a subsection on depression given its frequent co-existence and impact on cardiovascular disease.

"In the past 4 years, many of the national guideline organizations have launched new, evidence-based recommendations — from changes in medication management to new thresholds for lipid levels in secondary prevention," says Dr. Rahul Jain, co-chair of C-CHANGE and family physician at Sunnybrook Health Sciences Centre. "We hope this resource helps primary care clinicians stay up to date with many constantly evolving cardiovascular guidelines, so their patients can get the best care possible."