“Clinicians are rightly concerned that there are too many guidelines with too many individual recommendations to be practical and useful for everyday use, particularly in primary care. Typical patients with multiple diseases require 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 senior author of the latest C-CHANGE guideline. “We hope that this fourth update of the very popular guideline C-CHANGE will further meet the needs of healthcare professionals and patients, for the prevention and treatment of cardiovascular disease and related brain health with a simple harmonized approach.” An update to a 2018 publication, the Canadian Cardiovascular Harmonized National Guideline Endeavor (C-CHANGE) resource includes 48 new or revised recommendations out of 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 CVD, 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 behavior recommendations for all Canadians to address risk factors for these conditions, such as diet, smoking and physical activity.
C-CHANGE is all about singing from the same song sheet. 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 be significantly improved.”
Dr. Sheldon Tobe, C-CHANGE Co-Chair and Nephrologist at Sunnybrook Health Sciences Center
What is different from before?
More than 50% of the guideline contains new or revised recommendations from the previous version in 2018. This guideline is also more comprehensive and holistic in the care of patients with multimorbidity. The collaboration has expanded to include the Health Canada Dietary Guidelines, the Canadian Consensus Conference on the 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-occurrence and impact on cardiovascular disease. “Over the past 4 years, many of the national guidelines agencies have initiated 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 possible care.” Source: Canadian Medical Association Journal Journal Reference: Jain, R., et al. (2022) Canadian Cardiovascular Harmonized National Guideline Endeavor (C-CHANGE) for the prevention and management of cardiovascular disease in primary care: 2022 update. Canadian Medical Association Journal. doi.org/10.1503/cmaj.220138.
